CHIEF COMPLAINT: Mobitz [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] AV block w/ LBBB

PRESENT ILLNESS: 73 yo woman with hx of HTN, ? afib (never on anticoagulation)
and ? CVA was transferred from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] hospital after being
found to have Mobitz type II AV block w/ LBBB.  She presented to
the OSH this am c/o of dizziness since midnight, however says
she actually noted feeling "woozy" with standing for about 1
week.  She tolerated this until MN last night when she got out
of bed to use the bathroom and noted she was very dizzy.  Denied
any SOB, CP, N/V; She did have some diarrhea yesterday, but
denied any fever or chills, and no urinary symptoms.
.
The pt presented to OSH where she was found to be in 3rd degree
AV block on ECG.  She had transcut pacer pads placed, received
ASA 325mg x 1 and was medflighted to [**Hospital1 18**].
.
Here her ECG demonstrated Morbitz type II with LBBB.  She had a
temporary wire placed at bedside in R IJ position w/o any
complications

MEDICAL HISTORY: HTN

MEDICATION ON ADMISSION: Metoprolol 50mg PO bid
Amlodipine 10qd

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission:

FAMILY HISTORY: no CAD, CVA, DM, or thyroid disease

SOCIAL HISTORY: Married. 2 sons, 4 [**Name2 (NI) 69484**] a day for 40 years quit.  Takes 2
drinks with dinner.  No IVDU. Lives in [**Location 69485**].
Mobitz (type) II atrioventricular block,Unspecified essential hypertension,Unspecified late effects of cerebrovascular disease,Atrial fibrillation,Personal history of tobacco use,Other iatrogenic hypotension,Other diuretics causing adverse effects in therapeutic use
Atrioven block-mobitz ii,Hypertension NOS,Late effect CV dis NOS,Atrial fibrillation,History of tobacco use,Iatrogenc hypotnsion NEC,Adv eff diuretics NEC
Admission Date:  [**2141-7-15**]              Discharge Date:   [**2141-7-18**]

Date of Birth:  [**2068-3-4**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2901**]
Chief Complaint:
Mobitz [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] AV block w/ LBBB


Major Surgical or Invasive Procedure:
Placment of temporary pacemaker
Placement of permanent pacemaker

History of Present Illness:
73 yo woman with hx of HTN, ? afib (never on anticoagulation)
and ? CVA was transferred from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] hospital after being
found to have Mobitz type II AV block w/ LBBB.  She presented to
the OSH this am c/o of dizziness since midnight, however says
she actually noted feeling "woozy" with standing for about 1
week.  She tolerated this until MN last night when she got out
of bed to use the bathroom and noted she was very dizzy.  Denied
any SOB, CP, N/V; She did have some diarrhea yesterday, but
denied any fever or chills, and no urinary symptoms.
.
The pt presented to OSH where she was found to be in 3rd degree
AV block on ECG.  She had transcut pacer pads placed, received
ASA 325mg x 1 and was medflighted to [**Hospital1 18**].
.
Here her ECG demonstrated Morbitz type II with LBBB.  She had a
temporary wire placed at bedside in R IJ position w/o any
complications


Past Medical History:
HTN

Social History:
Married. 2 sons, 4 [**Name2 (NI) 69484**] a day for 40 years quit.  Takes 2
drinks with dinner.  No IVDU. Lives in [**Location 69485**].

Family History:
no CAD, CVA, DM, or thyroid disease

Physical Exam:
Admission:

VS: 98.6, 80 V paced, 150/50, 100% on 2L
Gen: NAD
HEENT: no JVD, MMM
CVS: ireg HR, nl s1 and s2, no m/g/r
lungs: CTABL
ABD: soft, NT/ND
Ext: no edema, 2+ DP


Pertinent Results:
Admission Labs:
.
[**2141-7-16**] 05:56AM BLOOD WBC-14.6* RBC-4.39 Hgb-14.0 Hct-40.5
MCV-92 MCH-31.9 MCHC-34.5 RDW-13.4 Plt Ct-258
[**2141-7-16**] 05:56AM BLOOD Plt Ct-258
[**2141-7-16**] 05:56AM BLOOD Glucose-138* UreaN-12 Creat-0.6 Na-140
K-3.7 Cl-103 HCO3-28 AnGap-13
[**2141-7-16**] 05:56AM BLOOD Calcium-8.9 Phos-3.0 Mg-2.1
.
Radiology:
CXR ([**2141-7-15**]): There is a right IJ line with tip projecting over
the right ventricle. The lungs are clear without infiltrate or
effusion. There is no pneumothorax.
CXR ([**2141-7-18**]): Standard position of right pacemaker leads with no
evidence of discontinuation. No pneumothorax. Left small pleural
effusion grossly unchanged.  No evidence of congestive heart
failure.
.
Other Labs:
[**2141-7-16**] 09:29AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.015
[**2141-7-16**] 09:29AM URINE Blood-LGE Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-SM
[**2141-7-16**] 09:29AM URINE Mucous-RARE
Urine cx ([**2141-7-16**])- 4000/ml Gram negative rods (discussed with
microbiology lab corresponding to 4000 colonies which was
insignificant)
Lyme serology ([**2141-7-17**]) - pending
Discharge Labs:
.
[**2141-7-18**] 06:20AM BLOOD WBC-11.3* RBC-3.74* Hgb-12.7 Hct-34.6*
MCV-93 MCH-34.0* MCHC-36.7* RDW-13.3 Plt Ct-194
[**2141-7-18**] 06:20AM BLOOD Plt Ct-194


Brief Hospital Course:
The patient is a 73 yo F w/ ? h/o afib, ? h/o CVA, HTN p/w
Mobitz [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] AV block w/ LBBB.  Her hospital course for this
admission is as follows:
.
1.  Morbitz type II AV block : temporary pacer placed when
patient first presented with Morbitz type II block as bridge to
permanent pacemaker.  Held BB for pre-permanent pacer placment;
permanent pacer placement on [**2141-7-17**].  Metoprol was restarted
initially at 25mg PO bid, titrated up to 50mg PO bid (her home
dose); Lyme titer was drawn to search for potential causes of
her AV block which was still pending at the time of discharge.
Will follow up with her Lyme titer after discharge
.
2.  HTN: Initially, we held BB as we don't want to supress any
escape foci shd her temp wire fail prior to her permanent
pacemaker placement, but continued outpt amlodipine 10mg PO
qday.  Once her permanent pacer was placed on [**2141-7-17**], we
restarted her metoprolol, and continued her amlodipine.
.
3. ? Afib: pt does not have any recollection of this. not on
aspirin or coumadin. She was told to follow up with her PCP for
follow up.
.
4. ? h/o CVA;  pt doesn't have any recollection of this.  Will
follow up with her PCP within [**Name Initial (PRE) **] week for further workup with
imaging. patient remained alert and oriented throughout her stay
with normal neuro exam.
.
5. ? urine cx - her initial UA showed 32 RBC, 0 WBC, occ
bacteria from her cath, and subsequent urine cx grew 4000
colonies/ml of gram negative rods.  Patient remained afebrile
throughout her stay, and had no urinary symptoms.  Discussed
with the microbiology lab (insignificant growth most likely from
contamination of cath) and infectious disease fellow on call
([**First Name8 (NamePattern2) 803**] [**Last Name (NamePattern1) **]).  Recommended no treatment if patient have no
symptoms and afebrile.
.
6. PPX: colace
.
7. Code: Full


Medications on Admission:
Metoprolol 50mg PO bid
Amlodipine 10qd

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily):
hold for SBP<100.
3. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day): hold for SBP<100 and HR<60.
4. Clindamycin HCl 300 mg Capsule Sig: One (1) Capsule PO four
times a day for 5 doses: Please take one dose tonight and four
doses tomorrow.
Disp:*5 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis
Morbitz type II AV block

Secondary Diagnosis
HTN


Discharge Condition:
stable in good condition, no fever, chest pain, SOB, Nausea or
vomiting.


Discharge Instructions:
If you experience chest pain, shortness of breath or fevers, or
any other serious medical conditions, please return to the
emergency room immediately
.
You should follow a cardiac healthy diet.
.
Please take all your medications as prescribed
.
Please follow up with your appointments


Followup Instructions:
Please follow up with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 24913**] [**Telephone/Fax (1) 32949**] next
Monday [**2141-7-24**] 11:30am, in adddition to the following
appointments

Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2141-7-24**]
3:30


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**]

Completed by:[**2141-7-19**]
{'Mobitz (type) II atrioventricular block,Unspecified essential hypertension,Unspecified late effects of cerebrovascular disease,Atrial fibrillation,Personal history of tobacco use,Other iatrogenic hypotension,Other diuretics causing adverse effects in therapeutic use'}


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: Mobitz [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] AV block w/ LBBB

PRESENT ILLNESS: 73 yo woman with hx of HTN, ? afib (never on anticoagulation)
and ? CVA was transferred from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] hospital after being
found to have Mobitz type II AV block w/ LBBB.  She presented to
the OSH this am c/o of dizziness since midnight, however says
she actually noted feeling "woozy" with standing for about 1
week.  She tolerated this until MN last night when she got out
of bed to use the bathroom and noted she was very dizzy.  Denied
any SOB, CP, N/V; She did have some diarrhea yesterday, but
denied any fever or chills, and no urinary symptoms.
.
The pt presented to OSH where she was found to be in 3rd degree
AV block on ECG.  She had transcut pacer pads placed, received
ASA 325mg x 1 and was medflighted to [**Hospital1 18**].
.
Here her ECG demonstrated Morbitz type II with LBBB.  She had a
temporary wire placed at bedside in R IJ position w/o any
complications

MEDICAL HISTORY: HTN

MEDICATION ON ADMISSION: Metoprolol 50mg PO bid
Amlodipine 10qd

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission:

FAMILY HISTORY: no CAD, CVA, DM, or thyroid disease

SOCIAL HISTORY: Married. 2 sons, 4 [**Name2 (NI) 69484**] a day for 40 years quit.  Takes 2
drinks with dinner.  No IVDU. Lives in [**Location 69485**]. 

### Response:
{'Mobitz (type) II atrioventricular block,Unspecified essential hypertension,Unspecified late effects of cerebrovascular disease,Atrial fibrillation,Personal history of tobacco use,Other iatrogenic hypotension,Other diuretics causing adverse effects in therapeutic use'}
