CHIEF COMPLAINT: Failed LV lead placement

PRESENT ILLNESS: This 49 year old male has an extensive history of coronary
artery  disease, dating back to [**2139**] when he had his first stent
placed. Since then, he has had multiple stents placed to the
LAD, LCX and RCA. He has LV dysfunction with an echo done in
[**2152-7-14**] demonstrating an EF of 30%-35%. He has symptoms of
shortness of breath with minimal activity such as walking [**Age over 90 **]
yards. He denies
any PND or orthopnea. He has chest pain with activity such as
doing heavy lifting but denies any chest pain at rest. He denies
any recent lightheadedness or palpitations. He was recently
evaluated by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for
biventricular ICD placement and was found to meet criteria. He
underwent implantation of a [**Company 1543**] BiV ICD, Concerto C154DWK
on [**2152-9-11**] and was discharged the following day. He returned to
the device clinic on [**2152-9-13**] when he developed stimulation of
his diaphram causing continuous hiccups. His LV lead was
deactivated and the patient returned for revision of his LV lead
however attempts were unsuccessful to place the lead. He is now
admitted for a thoracosopic LV lead placement.

MEDICAL HISTORY: Coronary artery disease status post multiple stent placements
in the LAD, left circumflex, and right coronary artery beginning

MEDICATION ON ADMISSION: Metformin 500 mg PO BID
Lisinopril 20 mg PO DAILY
Aspirin 325 mg
Metoprolol Succinate 50 mg Tablet

ALLERGIES: Adhesive Tape

PHYSICAL EXAM: Vital Signs: His blood pressure is
110/70, heart rate 70, and sats 96. Neck: JVP 6 cm. Carotids
without discernible bruits. No neck masses or thyroid masses.
Lungs: Clear. Heart: Regular rate and rhythm, good S1 and S2,
with an S3 gallop. Abdomen: Soft, nontender. Extremities:
Pulses are 1+ distally.

FAMILY HISTORY: father had a stent placed at age 73. mother has a LBBB.

SOCIAL HISTORY: Married with 3 children. He is currently not working. His wife
will bring him to the procedure and can be reached at [**Telephone/Fax (1) 41991**]. Drinks alcohol on occasion.
Mechanical complication of automatic implantable cardiac defibrillator,Other primary cardiomyopathies,Hemopericardium,Congestive heart failure, unspecified,Other left bundle branch block,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Mch cmp autm mplnt dfbrl,Prim cardiomyopathy NEC,Hemopericardium,CHF NOS,Left bb block NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Status-post ptca,Abn react-procedure NEC
Admission Date:  [**2152-9-21**]              Discharge Date:   [**2152-9-23**]

Date of Birth:  [**2103-2-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Adhesive Tape

Attending:[**Known firstname 922**]
Chief Complaint:
Failed LV lead placement

Major Surgical or Invasive Procedure:
[**2152-9-21**] - Thoracoscopic LV Lead Placement


History of Present Illness:
This 49 year old male has an extensive history of coronary
artery  disease, dating back to [**2139**] when he had his first stent
placed. Since then, he has had multiple stents placed to the
LAD, LCX and RCA. He has LV dysfunction with an echo done in
[**2152-7-14**] demonstrating an EF of 30%-35%. He has symptoms of
shortness of breath with minimal activity such as walking [**Age over 90 **]
yards. He denies
any PND or orthopnea. He has chest pain with activity such as
doing heavy lifting but denies any chest pain at rest. He denies
any recent lightheadedness or palpitations. He was recently
evaluated by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for
biventricular ICD placement and was found to meet criteria. He
underwent implantation of a [**Company 1543**] BiV ICD, Concerto C154DWK
on [**2152-9-11**] and was discharged the following day. He returned to
the device clinic on [**2152-9-13**] when he developed stimulation of
his diaphram causing continuous hiccups. His LV lead was
deactivated and the patient returned for revision of his LV lead
however attempts were unsuccessful to place the lead. He is now
admitted for a thoracosopic LV lead placement.

Past Medical History:
Coronary artery disease status post multiple stent placements
in the LAD, left circumflex, and right coronary artery beginning

in [**2139**] with subsequent interventions in [**2148**], [**2150**], and most
recently drug-eluting stents placed in the distal right in
12/[**2150**].
Long-standing left bundle-branch block.
Class III congestive heart failure symptoms
Depressed LV function with the recent echo showing an ejection
fraction of 30%.
Hypertension
Hyperlipidemia
Diabetes
Cardiomyopathy, s/p BiV ICD placementon [**2152-9-11**]
LBBB
Substance abuse in the [**2113**]/[**2123**] with marijuana, acid, ETOH;
denies using drugs presently


Social History:
Married with 3 children. He is currently not working. His wife
will bring him to the procedure and can be reached at [**Telephone/Fax (1) 41991**]. Drinks alcohol on occasion.


Family History:
father had a stent placed at age 73. mother has a LBBB.

Physical Exam:
Vital Signs: His blood pressure is
110/70, heart rate 70, and sats 96. Neck: JVP 6 cm. Carotids
without discernible bruits. No neck masses or thyroid masses.
Lungs: Clear. Heart: Regular rate and rhythm, good S1 and S2,
with an S3 gallop. Abdomen: Soft, nontender. Extremities:
Pulses are 1+ distally.


Pertinent Results:
[**2152-9-22**] 02:14AM BLOOD WBC-12.8* RBC-3.75* Hgb-11.6* Hct-32.6*
MCV-87 MCH-31.0 MCHC-35.7* RDW-14.7 Plt Ct-281
[**2152-9-21**] 09:10AM BLOOD WBC-5.4 RBC-3.81* Hgb-11.7* Hct-33.3*
MCV-88 MCH-30.8 MCHC-35.1* RDW-14.6 Plt Ct-255
[**2152-9-21**] 01:25PM BLOOD PT-13.8* PTT-20.3* INR(PT)-1.2*
[**2152-9-21**] 09:10AM BLOOD PT-13.7* PTT-22.0 INR(PT)-1.2*
[**2152-9-23**] 07:20AM BLOOD UreaN-16 Creat-0.9 K-4.2
[**2152-9-21**] 01:25PM BLOOD UreaN-18 Creat-0.8 Na-138 Cl-104 HCO3-24
    [**Known lastname 41992**],[**Known firstname 177**] E. [**Age over 90 41993**] M  49  [**2103-2-23**]

Radiology Report CHEST (PORTABLE AP) Study Date of [**2152-9-22**] 9:25
AM


[**Last Name (LF) **],[**Known firstname 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] CSRU [**2152-9-22**] SCHED
CHEST (PORTABLE AP)   Clip # [**Clip Number (Radiology) 41994**]
Reason: PTX



[**Hospital 93**] MEDICAL CONDITION:
   49 year old man s/p Left thoracoscopy/pacer lead placement
REASON FOR THIS EXAMINATION:
   PTX



Provisional Findings Impression: LCpc FRI [**2152-9-22**] 6:50 PM
No pneumothorax.


Final Report
CHEST, PORTABLE AP

REASON FOR EXAM: 49-year-old man status post left
thoracoscopy/pacer lead
placement. Rule out pneumothorax.

Since earlier today, the left chest tube was removed. There is
no
pneumothorax. There is otherwise no overall change since this
morning.


DR. [**First Name8 (NamePattern2) 4078**] [**Name (STitle) 4079**]
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]
Approved: SAT [**2152-9-23**] 8:34 AM

  Imaging Lab



Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2152-9-21**] for surgical
placement of his LV lead. He was taken directly to the operating
room where he underwent a thoracoscopic LV lead placement.
Please see operative note for details. Postoperatively he was
taken to the intensive care unit for monitoring.He was later
extubated without issue. He reported feeling typical anginal
symptoms that evening. He was treated per CP protocol: NTG
SL/O2/MSO4. 12 Lead EKG done.No evidence of ischemia. Cardiac
enzymes cycled negative. Cardiology consulted. No further
episodes occurred.  POD#1 the left CT was discontinued.
Mr.[**Known lastname **] was doing well and was transferred to the floor for
further monitoring and recovery. POD#2 He was cleared for
discharge to home. He was advised to follow up with Dr.[**Last Name (STitle) 914**]
in 2 weeks time and to have a CXR done prior to his appointment.


Medications on Admission:
Metformin 500 mg PO BID
Lisinopril 20 mg PO DAILY
Aspirin 325 mg
Metoprolol Succinate 50 mg Tablet

Discharge Medications:
1. Metformin 500 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day).
Disp:*90 Tablet(s)* Refills:*2*
2. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. Aspirin 325 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*
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 3 days.
Disp:*6 Tablet(s)* Refills:*0*
5. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 3 days.
Disp:*6 Packet(s)* Refills:*0*
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
7. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*2*
8. Outpatient Lab Work
CXR: PA/LAT->s/p left thorascopic LV lead placement 2 weeks
after discharge


Discharge Disposition:
Home with Service

Discharge Diagnosis:
[**2152-9-21**] - Thoracoscopic LV Lead Placement


Discharge Condition:
Stable


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) Call with any questions or concerns.


Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 914**] in 2 weeks.[**Telephone/Fax (1) **]*Please
have CXR done prior to appointment.
Scheduled Appointments:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 11767**] Date/Time:[**2152-11-3**] 9:40



Completed by:[**2152-9-23**]
{'Mechanical complication of automatic implantable cardiac defibrillator,Other primary cardiomyopathies,Hemopericardium,Congestive heart failure, unspecified,Other left bundle branch block,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,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: Failed LV lead placement

PRESENT ILLNESS: This 49 year old male has an extensive history of coronary
artery  disease, dating back to [**2139**] when he had his first stent
placed. Since then, he has had multiple stents placed to the
LAD, LCX and RCA. He has LV dysfunction with an echo done in
[**2152-7-14**] demonstrating an EF of 30%-35%. He has symptoms of
shortness of breath with minimal activity such as walking [**Age over 90 **]
yards. He denies
any PND or orthopnea. He has chest pain with activity such as
doing heavy lifting but denies any chest pain at rest. He denies
any recent lightheadedness or palpitations. He was recently
evaluated by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for
biventricular ICD placement and was found to meet criteria. He
underwent implantation of a [**Company 1543**] BiV ICD, Concerto C154DWK
on [**2152-9-11**] and was discharged the following day. He returned to
the device clinic on [**2152-9-13**] when he developed stimulation of
his diaphram causing continuous hiccups. His LV lead was
deactivated and the patient returned for revision of his LV lead
however attempts were unsuccessful to place the lead. He is now
admitted for a thoracosopic LV lead placement.

MEDICAL HISTORY: Coronary artery disease status post multiple stent placements
in the LAD, left circumflex, and right coronary artery beginning

MEDICATION ON ADMISSION: Metformin 500 mg PO BID
Lisinopril 20 mg PO DAILY
Aspirin 325 mg
Metoprolol Succinate 50 mg Tablet

ALLERGIES: Adhesive Tape

PHYSICAL EXAM: Vital Signs: His blood pressure is
110/70, heart rate 70, and sats 96. Neck: JVP 6 cm. Carotids
without discernible bruits. No neck masses or thyroid masses.
Lungs: Clear. Heart: Regular rate and rhythm, good S1 and S2,
with an S3 gallop. Abdomen: Soft, nontender. Extremities:
Pulses are 1+ distally.

FAMILY HISTORY: father had a stent placed at age 73. mother has a LBBB.

SOCIAL HISTORY: Married with 3 children. He is currently not working. His wife
will bring him to the procedure and can be reached at [**Telephone/Fax (1) 41991**]. Drinks alcohol on occasion. 

### Response:
{'Mechanical complication of automatic implantable cardiac defibrillator,Other primary cardiomyopathies,Hemopericardium,Congestive heart failure, unspecified,Other left bundle branch block,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
