CHIEF COMPLAINT: s/p cath with hypotension

PRESENT ILLNESS: 55 yo male inmate who fell out of bunk bed, found seizing,
shocked twice, intubated. EKG showed inferior STE with lateral
STD and anterior STD. He received lidocaine 2 mg, then lidocaine
drip, lopressor, valium 10 mg IV x3, dilantin 1 gram IV, [**First Name3 (LF) **] 325
mg, heparin drip. He also got vecuronium, etomidate for
intubation.
CK 206, Trop I 0.6, WBC 12.7
EKG: Sinus, STE inferiorly, ST depression anterolaterally.
EF 35%
Cath showed total occlusion of LCX which was stented. IABP was
placed for  hypotension. He was started on neosynephrine and
dopamine in the cath lab. He was also given antibiotics and
steroids for question of dye allergy. CO 10.68, CI 5.32, RA 9,
RV 37/6, PA 35/13, mean 21, PCW 11.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: ?antihypertensive medication

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: Afebrile, BP: 80-100/50-60, HR 80's, RR 18 on vent, 100% on vent
GENL: intubated, sedated
HEENT: Intubated
CV: RRR +systolic murmur
LUNGS: CAT
ABD: soft, nt, nd, +bs
Ext: trace pedal edema
Skin: erythmatous rash on buttocks

FAMILY HISTORY: 

SOCIAL HISTORY: In prison
Acute myocardial infarction of other inferior wall, initial episode of care,Other convulsions,Paroxysmal ventricular tachycardia,Other specified hypotension,Coronary atherosclerosis of native coronary artery,Accidental fall from bed
AMI inferior wall, init,Convulsions NEC,Parox ventric tachycard,Hypotension NEC,Crnry athrscl natve vssl,Fall from bed
Admission Date:  [**2201-4-21**]              Discharge Date:   [**2201-4-25**]

Date of Birth:  [**2146-2-5**]             Sex:   M

Service: MEDICINE

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 2698**]
Chief Complaint:
s/p cath with hypotension

Major Surgical or Invasive Procedure:
Cardiac catheterization s/p stent to LCX


History of Present Illness:
55 yo male inmate who fell out of bunk bed, found seizing,
shocked twice, intubated. EKG showed inferior STE with lateral
STD and anterior STD. He received lidocaine 2 mg, then lidocaine
drip, lopressor, valium 10 mg IV x3, dilantin 1 gram IV, [**First Name3 (LF) **] 325
mg, heparin drip. He also got vecuronium, etomidate for
intubation.
CK 206, Trop I 0.6, WBC 12.7
EKG: Sinus, STE inferiorly, ST depression anterolaterally.
EF 35%
Cath showed total occlusion of LCX which was stented. IABP was
placed for  hypotension. He was started on neosynephrine and
dopamine in the cath lab. He was also given antibiotics and
steroids for question of dye allergy. CO 10.68, CI 5.32, RA 9,
RV 37/6, PA 35/13, mean 21, PCW 11.

Past Medical History:
Hypertension

Social History:
In prison

Physical Exam:
Afebrile, BP: 80-100/50-60, HR 80's, RR 18 on vent, 100% on vent
GENL: intubated, sedated
HEENT: Intubated
CV: RRR +systolic murmur
LUNGS: CAT
ABD: soft, nt, nd, +bs
Ext: trace pedal edema
Skin: erythmatous rash on buttocks

Pertinent Results:
 Echo:
 Left ventricular wall thicknesses and cavity size are normal.
There is
 moderate regional left ventricular systolic dysfunction with
dyskinesis of the basal half of the inferior wall and akinesis
of the basal half of the inferolateral wall. The remaining
segments contract well (overall). Trace aortic regurgitation is
seen. No mitral regurgitation is seen. Physiologic mitral
regurgitation is seen (within normal limits). There is an
anterior space which most likely represents a fat pad.
-
-

[**2201-4-25**] 06:55AM BLOOD WBC-7.4 RBC-4.29* Hgb-12.3* Hct-36.7*
MCV-86 MCH-28.7 MCHC-33.5 RDW-13.5 Plt Ct-181
[**2201-4-21**] 07:58PM BLOOD Neuts-80* Bands-12* Lymphs-6* Monos-1*
Eos-0 Baso-0 Atyps-0 Metas-1* Myelos-0
[**2201-4-23**] 04:12AM BLOOD Neuts-79.7* Lymphs-14.5* Monos-5.0
Eos-0.5 Baso-0.3
[**2201-4-21**] 07:58PM BLOOD WBC-14.4* RBC-4.96 Hgb-14.3 Hct-41.5
MCV-84 MCH-28.9 MCHC-34.5 RDW-12.9 Plt Ct-210
[**2201-4-25**] 06:55AM BLOOD Plt Ct-181
[**2201-4-24**] 02:08AM BLOOD PT-12.4 PTT-24.4 INR(PT)-1.0
[**2201-4-25**] 06:55AM BLOOD Glucose-88 UreaN-12 Creat-0.8 Na-142
K-4.1 Cl-104 HCO3-28 AnGap-14
[**2201-4-21**] 07:58PM BLOOD Glucose-185* UreaN-11 Creat-0.7 Na-143
K-4.2 Cl-110* HCO3-23 AnGap-14
[**2201-4-24**] 02:08AM BLOOD CK(CPK)-924*
[**2201-4-23**] 04:12AM BLOOD ALT-43* AST-81* CK(CPK)-1025* AlkPhos-75
TotBili-0.2
[**2201-4-22**] 12:15PM BLOOD CK(CPK)-1777*
[**2201-4-22**] 04:10AM BLOOD CK(CPK)-2085*
[**2201-4-21**] 07:58PM BLOOD ALT-59* AST-95* LD(LDH)-403*
CK(CPK)-1483* AlkPhos-91 TotBili-0.5
[**2201-4-24**] 02:08AM BLOOD CK-MB-9
[**2201-4-23**] 04:12AM BLOOD CK-MB-46* MB Indx-4.5 cTropnT-1.36*
[**2201-4-22**] 12:15PM BLOOD CK-MB-151* MB Indx-8.5*
[**2201-4-22**] 04:10AM BLOOD CK-MB-268* MB Indx-12.9* cTropnT-2.76*
[**2201-4-21**] 07:58PM BLOOD CK-MB-178* MB Indx-12.0* cTropnT-0.98*
[**2201-4-25**] 06:55AM BLOOD Mg-1.9
[**2201-4-21**] 07:58PM BLOOD Albumin-4.3 Calcium-8.8 Phos-1.6* Mg-1.6
[**2201-4-24**] 02:08AM BLOOD LDLmeas-72
[**2201-4-23**] 04:12AM BLOOD Triglyc-657* HDL-36 CHOL/HD-4.7
LDLmeas-52
[**2201-4-21**] 11:30PM BLOOD Cortsol-36.7*
[**2201-4-24**] 02:08AM BLOOD Phenyto-21.1*

Brief Hospital Course:
55 yo M s/p fall from bunk bed, seizure, STEMI, s/p cath with
stent to LCX, post cath course complicated by hypotension
requiring pressors, intra-aoritc ballon pump.
1. STEMI: His EKG showed SR, STE in inferior leads and SFD in
lateral leads. He ruled in by enzymes. He is S/P cath with stent
to LCX. He was started on [**Last Name (LF) 4532**], [**First Name3 (LF) **], metoprolol and
lisinopril. He will need 6 months of [**First Name3 (LF) 4532**]. His repeat echo
showed an improved EF of 55% from 35% peri-MI. He does not
required ICD given that he had an MI and that explains his VT/VF
arrest.
2. Hypotension: Initial differential included cardiogenic shock
v. septic shock v. acute blood loss. Swan numbers more c/w
sepsis (CO 10 and CI 5.5). Dopamine and neosyephrine were weaned
shortly after arrival to CCU. IABP was discontinued. His BP was
stable. Cultures drawn but no growth. He was started on
vancomycin, levofloxacin and flagyl. Antibiotics were
discontinued after 48 hours after no growth of cultures and no
fever or elevated WBC. There was also concern for RP bleed post
cath given his hypotnesion. CT was negative for RP bleed.
3. Respiratory: He was intubated in field during seizure. He was
extubated on HD 2 without complication.
4. Fall: Neck CT with no fracture. No tenderness to suggest
ligamentous injury. Neck cleared on HD 2 and collar removed.
5. Seizures: Neurology team consulted on the patient. He was
reloaded with dilantin and placed on dilantin 100 mg TID.
Neurology recommended weaning the dilantin over 2 weeks. His
seizure was felt to be secondary to his STEMI. He would benefit
from an outpatient MRI to [**Doctor First Name **];uate for potential predisposition
to seizure.
6. Disposition: He was medically stable for discharge on
[**2201-4-25**]. His ambulating oxygen sat was 92%. He was able to walk
up 12 stairs. He was slightly unsteady and deconditioned on his
feet and would benefit from physical therapy.

Medications on Admission:
?antihypertensive medication

Discharge Medications:
1. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*6*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Atenolol 50 mg Tablet Sig: 1.5 Tablets PO once a day.
7. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO BID (2 times a day) for 5 days: Take 100 mg [**Hospital1 **] for 5 days,
then 100 mg QD for 5 days, then stop.
Disp:*30 Capsule(s)* Refills:*0*


Discharge Disposition:
Extended Care

Discharge Diagnosis:
STEMI
Seizures


Discharge Condition:
Good

Discharge Instructions:
Take all medications as prescribed. You now take medications for
your heart attack. You need to take [**Hospital1 4532**] for at least 6 months
because of your stent. You should not stop until told to do so
by your cardiolgist.
Follow up with a cardiologist within 1-2 months.
You need an MRI of your brain to evaluate for any predisposition
for seizures.

Followup Instructions:
Follow up with a cardiologist within 1-2 months.
You need an MRI of your brain to evaluate for any predisposition
for seizures.
{'Acute myocardial infarction of other inferior wall, initial episode of care,Other convulsions,Paroxysmal ventricular tachycardia,Other specified hypotension,Coronary atherosclerosis of native coronary artery,Accidental fall from bed'}


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: s/p cath with hypotension

PRESENT ILLNESS: 55 yo male inmate who fell out of bunk bed, found seizing,
shocked twice, intubated. EKG showed inferior STE with lateral
STD and anterior STD. He received lidocaine 2 mg, then lidocaine
drip, lopressor, valium 10 mg IV x3, dilantin 1 gram IV, [**First Name3 (LF) **] 325
mg, heparin drip. He also got vecuronium, etomidate for
intubation.
CK 206, Trop I 0.6, WBC 12.7
EKG: Sinus, STE inferiorly, ST depression anterolaterally.
EF 35%
Cath showed total occlusion of LCX which was stented. IABP was
placed for  hypotension. He was started on neosynephrine and
dopamine in the cath lab. He was also given antibiotics and
steroids for question of dye allergy. CO 10.68, CI 5.32, RA 9,
RV 37/6, PA 35/13, mean 21, PCW 11.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: ?antihypertensive medication

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: Afebrile, BP: 80-100/50-60, HR 80's, RR 18 on vent, 100% on vent
GENL: intubated, sedated
HEENT: Intubated
CV: RRR +systolic murmur
LUNGS: CAT
ABD: soft, nt, nd, +bs
Ext: trace pedal edema
Skin: erythmatous rash on buttocks

FAMILY HISTORY: 

SOCIAL HISTORY: In prison 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Other convulsions,Paroxysmal ventricular tachycardia,Other specified hypotension,Coronary atherosclerosis of native coronary artery,Accidental fall from bed'}
