CHIEF COMPLAINT: hypotension s/p BiV-ICD placement in OR

PRESENT ILLNESS: 69M with DM, non-ischemic CM (EF 20-25%)s/p bivi/ICD placement
in OR with hypotension/decreased urine output.   Clean
coronaries on cath 4/[**2108**].  Attempt at BiVi implant in [**Country 11150**]
unsuccessful.  Transfer to [**Hospital1 18**] [**6-12**] for re-attempt.  RV lead
placed OK but could not place CS lead.  To OR [**6-14**] for
epicardial LV lead.  Tolerated procedure well.  Post op, SBP
down to 80s from baseline 110-120, UOP down to 9cc/hr. Pt has
received 3L IVF since OR.

MEDICAL HISTORY: CM (EF 20-25%)
LBBB
DM
CRI
Enlarged prostate

MEDICATION ON ADMISSION: losartan 100
lasix 40
aldactone 25
digoxin 0.25 M-F, hold S and Sun
Coreg 12.5 [**Hospital1 **]
Ticlid (held 4d PTA)
ASA 325 (held 2d PTA)
MVI
Terazosin 2
protonix 40
amaryl 2
zocor 5
Insulin H. Actrapid 20-20-0, H. Mixtard 0-0-26

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 101.8/100.8 P: 100-110  BP:99-110/57-63 RR: 18-27 )2: 98-99%
I/O: 4610/1050 (630ccUOP, 350 cc CT (dark serosanguinous
drainage)
CT no longer on wall suction
Gen: pt sitting up in bed, appears uncomfortable, but NAD
HEENT: PERRL, sclerae anicteric, mm-dry; no JVP appreciated
Cardiac: rrr; +SEM, ? diastolic murmur
lungs: cta ant
abd: soft, + distention, no suprapubic pain but diffuse upper
epigastric pain on palpation (LUQ most signficant pain per pt)
ext: warm/dry; +DP pulses

FAMILY HISTORY: 

SOCIAL HISTORY: pt traveled from [**Country 11150**] for BiV-ICD placement. Nephew is
radiologist here at [**Hospital1 18**]
Congestive heart failure, unspecified,Other primary cardiomyopathies,Atrial fibrillation,Mitral valve disorders,Unspecified septicemia,Severe sepsis,Pneumonia, organism unspecified,Other specified hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other left bundle branch block,Unspecified disorder of kidney and ureter,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Long-term (current) use of insulin
CHF NOS,Prim cardiomyopathy NEC,Atrial fibrillation,Mitral valve disorder,Septicemia NOS,Severe sepsis,Pneumonia, organism NOS,Hypotension NEC,DMII wo cmp nt st uncntr,Left bb block NEC,Renal & ureteral dis NOS,BPH NOS w/o ur obs/LUTS,Long-term use of insulin
Admission Date:  [**2109-6-13**]              Discharge Date:   [**2109-6-20**]

Date of Birth:  [**2039-12-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
hypotension s/p BiV-ICD placement in OR

Major Surgical or Invasive Procedure:
Surgical epicardial lead placement of BiV pacemaker
Placement of BiV pacemaker.
Central line placement.


History of Present Illness:
 69M with DM, non-ischemic CM (EF 20-25%)s/p bivi/ICD placement
in OR with hypotension/decreased urine output.   Clean
coronaries on cath 4/[**2108**].  Attempt at BiVi implant in [**Country 11150**]
unsuccessful.  Transfer to [**Hospital1 18**] [**6-12**] for re-attempt.  RV lead
placed OK but could not place CS lead.  To OR [**6-14**] for
epicardial LV lead.  Tolerated procedure well.  Post op, SBP
down to 80s from baseline 110-120, UOP down to 9cc/hr. Pt has
received 3L IVF since OR.

Past Medical History:
CM (EF 20-25%)
LBBB
DM
CRI
Enlarged prostate

Social History:
pt traveled from [**Country 11150**] for BiV-ICD placement. Nephew is
radiologist here at [**Hospital1 18**]

Physical Exam:
T: 101.8/100.8 P: 100-110  BP:99-110/57-63 RR: 18-27 )2: 98-99%
I/O: 4610/1050 (630ccUOP, 350 cc CT (dark serosanguinous
drainage)
CT no longer on wall suction
Gen: pt sitting up in bed, appears uncomfortable, but NAD
HEENT: PERRL, sclerae anicteric, mm-dry; no JVP appreciated
Cardiac: rrr; +SEM, ? diastolic murmur
lungs: cta ant
abd: soft, + distention, no suprapubic pain but diffuse upper
epigastric pain on palpation (LUQ most signficant pain per pt)
ext: warm/dry; +DP pulses


Pertinent Results:
[**2109-6-13**] 10:00AM   GLUCOSE-124* UREA N-21* CREAT-1.2 SODIUM-140
POTASSIUM-4.3 CHLORIDE-102 TOTAL CO2-28 ANION GAP-14
[**2109-6-13**] 10:00AM   CALCIUM-9.9 PHOSPHATE-3.5 MAGNESIUM-2.0
[**2109-6-13**] 10:00AM   WBC-7.7 RBC-5.36 HGB-13.5* HCT-42.5 MCV-79*
MCH-25.1* MCHC-31.7 RDW-18.1*
[**2109-6-13**] 10:00AM   PLT COUNT-280
[**2109-6-13**] 10:00AM   PT-11.7 PTT-20.4* INR(PT)-0.9

Brief Hospital Course:
Mr. [**Known lastname 1603**] is a 69M who is s/p operative BiV/ICD placement c/b
hypotension and decreased urine output.  In particular, after
placement of BiV pacemaker/ICD, the patient developed
hypotension.  He was placed on Neosynephrine for a short period
of time and responded well with MAPs >65.  Initially the
differential of the hypotension included sepsis, cardiogenic
shock, tamponade, and dehydration.  However, 2 ECHO's did not
show evidence of tamponade, and the swan catheter did not
support cardiogenic shock.  The fever and elevated white count
was consistent with sepsis, especially in the setting of
presumed PNA and lung infiltration.  Zosyn and vanco were
started for presumed nosocomial infection or infection d/t
surgery.  BB, ACE, and lasix, and aldactone were initially held,
but losartan waw restarted and titrated up to home dose, and
[**Last Name (un) 61755**] was started and kept at 1/2 home dose.  Lasix IV was
subsequently used when patient demonstrated fluid overload,
improving the patient's breathing and clinical status.

After pacemaker/ICD placement on [**6-13**], the patient was started
on Vanc per recommendations of CSurg.  He was atrial-sensed and
v-paced.  On [**6-16**] he was found to be in a-fib and intermittent
VT. Initially the plan was to wait until [**6-17**] for DCCV and load
the patient with ibutilide and lidocaine and start him on amio
on [**6-16**].  However, the patient was hypotensive and concern there
was concern that was causing this hypotenion. The patient was
cardioverted on [**6-16**] and returned to sinus rhythm (V paced).

In regards to ID, the Pt spiked a fever to 101.8 post-op.
Pneumonia was considered as a cause of the fever and hypotension
for several reasons, including complicated OR course of
intubation and adjusting lung volumes as needed for placement of
leads of pacemaker, developing a new productive cough, and
having infiltrates on CXR.  Pt was started on vancomycin per
protocol of pacemaker placement and given dose of levofloxacin
in PACU for fever. However, in the CCU levo was changed to zosyn
due to concern for nocosomial infection and to avoid prolongued
QT interval, and this was continued until discharge.  Laboratory
data did not definitively confirm the source of infection, as
sputum cultures revealed only moderate growth of oropharyngeal
flora ([**6-17**], after antibiotics had already begun), urine
cultures were negative, and blood cultures did not demonstrate
growth.

In regards to his CHF and cardiac status, digoxin was held d/t
dig toxicity (level 1.3), while ASA and zocor were continued.
As hypotension improved metoprolol was added, as well as
losartan and coreg.  BP tolerated these medication additions
well

Patient has underlying diabetes and was placed on an insulin
sliding scale while in the hospital.  He also received SQ
heparin and protonix as prophylactic measures for DVT and
gastric bleed, respectively.  The patient remained full code
during this hospitalization.


Medications on Admission:
losartan 100
lasix 40
aldactone 25
digoxin 0.25 M-F, hold S and Sun
Coreg 12.5 [**Hospital1 **]
Ticlid (held 4d PTA)
ASA 325 (held 2d PTA)
MVI
Terazosin 2
protonix 40
amaryl 2
zocor 5
Insulin H. Actrapid 20-20-0, H. Mixtard 0-0-26

Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
2. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Please take a total of 400 mg (2 tablets) [**Hospital1 **] for 2 days
(until [**6-23**]), then take 200 mg (1 tablet) [**Hospital1 **] for 7 days, then
take 200 mg (1 tablet) qD from then on.
Disp:*120 Tablet(s)* Refills:*0*
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
7. Losartan Potassium 50 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*0*
8. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1)
Tablet PO Q12H (every 12 hours) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
9. Pneumococcal 23-ValPS Vaccine 25 mcg/0.5 mL Injectable Sig:
One (1) ML Injection ONCE (once) for 1 doses.
10. Please return to your normal insulin regimen.


Discharge Disposition:
Home

Discharge Diagnosis:
Non-ischemic cardiomyopathy
Type 2 Diabetes
Hypertension
Cardiac Arrhythmia

Discharge Condition:
Stable

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet.
Fluid Restriction: 1.5 liters per day.
Take your medications as instructed.  Please follow up with
electrophysiology on [**6-28**].

Followup Instructions:
DEVICE CLINIC Where: [**Hospital6 29**] CARDIAC SERVICES
Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2109-6-28**] 1:30pm.

You will have an appointment with Dr. [**Last Name (STitle) **] after your
device clinic appointment.
{'Congestive heart failure, unspecified,Other primary cardiomyopathies,Atrial fibrillation,Mitral valve disorders,Unspecified septicemia,Severe sepsis,Pneumonia, organism unspecified,Other specified hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other left bundle branch block,Unspecified disorder of kidney and ureter,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Long-term (current) use of insulin'}


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: hypotension s/p BiV-ICD placement in OR

PRESENT ILLNESS: 69M with DM, non-ischemic CM (EF 20-25%)s/p bivi/ICD placement
in OR with hypotension/decreased urine output.   Clean
coronaries on cath 4/[**2108**].  Attempt at BiVi implant in [**Country 11150**]
unsuccessful.  Transfer to [**Hospital1 18**] [**6-12**] for re-attempt.  RV lead
placed OK but could not place CS lead.  To OR [**6-14**] for
epicardial LV lead.  Tolerated procedure well.  Post op, SBP
down to 80s from baseline 110-120, UOP down to 9cc/hr. Pt has
received 3L IVF since OR.

MEDICAL HISTORY: CM (EF 20-25%)
LBBB
DM
CRI
Enlarged prostate

MEDICATION ON ADMISSION: losartan 100
lasix 40
aldactone 25
digoxin 0.25 M-F, hold S and Sun
Coreg 12.5 [**Hospital1 **]
Ticlid (held 4d PTA)
ASA 325 (held 2d PTA)
MVI
Terazosin 2
protonix 40
amaryl 2
zocor 5
Insulin H. Actrapid 20-20-0, H. Mixtard 0-0-26

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 101.8/100.8 P: 100-110  BP:99-110/57-63 RR: 18-27 )2: 98-99%
I/O: 4610/1050 (630ccUOP, 350 cc CT (dark serosanguinous
drainage)
CT no longer on wall suction
Gen: pt sitting up in bed, appears uncomfortable, but NAD
HEENT: PERRL, sclerae anicteric, mm-dry; no JVP appreciated
Cardiac: rrr; +SEM, ? diastolic murmur
lungs: cta ant
abd: soft, + distention, no suprapubic pain but diffuse upper
epigastric pain on palpation (LUQ most signficant pain per pt)
ext: warm/dry; +DP pulses

FAMILY HISTORY: 

SOCIAL HISTORY: pt traveled from [**Country 11150**] for BiV-ICD placement. Nephew is
radiologist here at [**Hospital1 18**] 

### Response:
{'Congestive heart failure, unspecified,Other primary cardiomyopathies,Atrial fibrillation,Mitral valve disorders,Unspecified septicemia,Severe sepsis,Pneumonia, organism unspecified,Other specified hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other left bundle branch block,Unspecified disorder of kidney and ureter,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Long-term (current) use of insulin'}
