CHIEF COMPLAINT: cardiac arrest

PRESENT ILLNESS: 82 M with h/o IPF (on chronic steroids), PVD, h/o VT (on
dofetilide), and P.D.  He was last seen at [**Hospital1 18**]-[**Location (un) 620**]
cardiology clinic [**4-25**] (one month prior to admission).  He was
at home being cared for by his wife, daughter, and nurses and
was noted to be "much improved" but using continual O2 and
having increased SOB in the last few weeks.  He denied chest
discomfort or palpitations but did report occasional
lightheadedness without falls.
.
On the evening of presentation, he was leaving a restaurant
after father's day dinner.  He sat down in the passenger seat,
complained of fatigue, then became acutely SOB; changes in
position did not help these sx.  His family started to drive to
the ED, but the patient passed out, turned blue, and his eyes
rolled back in his head.  He was promptly removed from the car
and received CPR from his daughter who is [**Name8 (MD) **] RN until EMS
arrived when he was noted to be in asystolic arrest.  EMS
administered epi, lido, and atropine and intubated the patient.
He was brought to [**Location (un) 620**] ED where he was in SR w/NSVT.  ECG
demonstrated ST depression in V2-4.  The patient was given
amiodarone for his NSVT which decreased his HR to 100s.  He was
then trasferred to [**Hospital1 18**].  Labs pending at time of transfer
demonstrated Na 141, K 4.3, Cl 103, CO2 22.9, Glucose 123, BUN
21, Creatinine 1.3, Ca 8.8, Mg 2.2, Albumin 3.7, Protein 6.8,
TBili .66, AlkPhos 118, ALT 25, AST 27, CPK 42, INR 1.2, PTT 31,
WBC 9.5, HCT 38.3, MCV 86.6, PLT 201, N59L34M7 and ABG of
7.3/33/155 on CMV550X2 40 5.
...
MEDICATIONS:
Sinemet 25/100 2 tabs at 9:00 a.m., 1.5 tabs 11:00 a.m., 1 tab
4:00 p.m. Prednisone 2.5. Quinaglute 325 q.12 hours. Omeprazole
20 q.a.m.. P.R.N. Colace, Senokot. ASA 81, MVI 1 daily. Zocor on
hold.
...

MEDICAL HISTORY: Past Medical History:
   1. Orthostatic hypotension (? Shy-[**Last Name (un) **]).
   2. Diastolic congestive heart failure.
   3. RMVT (repetitive monomorphic VT presumably from RVOT
origin).
   4. Coronary artery disease/CA calcification.
   5. Dyslipidemia.
   6. Peripheral vascular disease (status amputation right first
toe [**2168-11-23**]).
   7. Pulmonary fibrosis.
   8. Chronic obstructive pulmonary disease.
   9. Parkinsonism with probable Shy-[**Last Name (un) **].
   10. Episodic gout.
   11. Chronic respiratory failure.
   12. Past hypermagnesemia.
   13. Last echo [**2168-7-13**] w/EF 55-60% and 1+ MR

MEDICATION ON ADMISSION: Sinemet 25/100 2 tabs at 8AM, 1.5 mg Q 1PM, 1 tab 4PM
Prednisone 2.5 mg QD
Quinidine 324 mg SA [**Hospital1 **]
Simvastatin 20 mg QHS
HCTZ/Spironolactone 25/25 Q MWF
Omeprazole QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: NC

SOCIAL HISTORY: lives at home with wife, who is HCP. Former [**Name2 (NI) 1818**], quit.
Blueprint shop-->chemical exposures.
Other premature beats,Acute respiratory failure,Bacteremia,Methicillin susceptible pneumonia due to Staphylococcus aureus,Postinflammatory pulmonary fibrosis,Diastolic heart failure, unspecified,Urinary tract infection, site not specified,Infection with microorganisms resistant to penicillins,Paralysis agitans,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site
Premature beats NEC,Acute respiratry failure,Bacteremia,Meth sus pneum d/t Staph,Postinflam pulm fibrosis,Diastolc hrt failure NOS,Urin tract infection NOS,Inf mcrg rstn pncllins,Paralysis agitans,Proteus infection NOS
Admission Date:  [**2169-5-27**]              Discharge Date:   [**2169-6-6**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
cardiac arrest

Major Surgical or Invasive Procedure:
Intubation and extubation
PICC line placement


History of Present Illness:
82 M with h/o IPF (on chronic steroids), PVD, h/o VT (on
dofetilide), and P.D.  He was last seen at [**Hospital1 18**]-[**Location (un) 620**]
cardiology clinic [**4-25**] (one month prior to admission).  He was
at home being cared for by his wife, daughter, and nurses and
was noted to be "much improved" but using continual O2 and
having increased SOB in the last few weeks.  He denied chest
discomfort or palpitations but did report occasional
lightheadedness without falls.
.
On the evening of presentation, he was leaving a restaurant
after father's day dinner.  He sat down in the passenger seat,
complained of fatigue, then became acutely SOB; changes in
position did not help these sx.  His family started to drive to
the ED, but the patient passed out, turned blue, and his eyes
rolled back in his head.  He was promptly removed from the car
and received CPR from his daughter who is [**Name8 (MD) **] RN until EMS
arrived when he was noted to be in asystolic arrest.  EMS
administered epi, lido, and atropine and intubated the patient.
He was brought to [**Location (un) 620**] ED where he was in SR w/NSVT.  ECG
demonstrated ST depression in V2-4.  The patient was given
amiodarone for his NSVT which decreased his HR to 100s.  He was
then trasferred to [**Hospital1 18**].  Labs pending at time of transfer
demonstrated Na 141, K 4.3, Cl 103, CO2 22.9, Glucose 123, BUN
21, Creatinine 1.3, Ca 8.8, Mg 2.2, Albumin 3.7, Protein 6.8,
TBili .66, AlkPhos 118, ALT 25, AST 27, CPK 42, INR 1.2, PTT 31,
WBC 9.5, HCT 38.3, MCV 86.6, PLT 201, N59L34M7 and ABG of
7.3/33/155 on CMV550X2 40 5.
...
MEDICATIONS:
Sinemet 25/100 2 tabs at 9:00 a.m., 1.5 tabs 11:00 a.m., 1 tab
4:00 p.m. Prednisone 2.5. Quinaglute 325 q.12 hours. Omeprazole
20 q.a.m.. P.R.N. Colace, Senokot. ASA 81, MVI 1 daily. Zocor on
hold.
...


Past Medical History:
Past Medical History:
   1. Orthostatic hypotension (? Shy-[**Last Name (un) **]).
   2. Diastolic congestive heart failure.
   3. RMVT (repetitive monomorphic VT presumably from RVOT
origin).
   4. Coronary artery disease/CA calcification.
   5. Dyslipidemia.
   6. Peripheral vascular disease (status amputation right first
toe [**2168-11-23**]).
   7. Pulmonary fibrosis.
   8. Chronic obstructive pulmonary disease.
   9. Parkinsonism with probable Shy-[**Last Name (un) **].
   10. Episodic gout.
   11. Chronic respiratory failure.
   12. Past hypermagnesemia.
   13. Last echo [**2168-7-13**] w/EF 55-60% and 1+ MR

Social History:
lives at home with wife, who is HCP. Former [**Name2 (NI) 1818**], quit.
Blueprint shop-->chemical exposures.


Family History:
NC


Pertinent Results:
TTE ([**5-29**]) - normal LA size, 1+ MR, EF>55%, normal LV thickness

Brief Hospital Course:
A/P: 82 year old man with multiple medical problems admitted s/p
resuscitated cardiac  arrest.
.
Cardiac arrest- Without cardiac monitoring during the event, the
cardiac arrest was initially of unclear etiology, VT/VF vs. PEA
secondary to hypoxia.  On admission, the patient was ruled out
for an MI.  He was started on ASA, statin, and beta blocker.
TTE showed good systolic function, normal LA size, and no wall
motion abnormalities.  On telemetry, he maintained persistent
ventricular premature beats without sustained VT.  Upon further
history, patient had multiple syncopal events before admission,
and was put on quinidine empirically.  The source of the
presumed arrhythmia has not been identified by EP study.  By
history, patient's syncopal symptoms improved with quinidine.
The cardiac arrest leading to the admission is is now thought to
likely be PEA arrest secondary to hypoxia from his primary
pulmonary disease and noncompliance with home oxygen.  EP
recommended restarting quinidine, keeping beta blocker at low
dose, and giving the patient [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts monitor upon
discharge.  Mr. [**Known lastname 21781**] had an episode of hypotension and
lethargy when his beta blocker was increased.  As the patient
has a history of syncope, the decision was made to discontinue
the beta blocker.  He is to f/u with Dr. [**Last Name (STitle) 3321**] from EP.
.
CHF- Mr. [**Known lastname 21781**] has a diagnosis of diastolic CHF, with
preserved EF.  He was maintained on ASA, statin and beta blocker
throughout his admission.  He appeared clinically fluid
overloaded on admission, but diuresed to a euvolemic state.  He
should f/u with his cardiologist as needed as an outpatient.
.
Resp failure- His cardiac arrest is thought to have been PEA
secondary to hypoxia.  He has had an unclear diagnosis of
primary pulmonary disease.  He was initially thought to have an
IPF process, however CT was negative per outpatient
pulmonologist, Dr. [**Last Name (STitle) **].  He has been on chronic prednisone for
suspected fibrosis in the past, and has been undergoing a
difficult and slow taper as an outpatient.  He has been on
prednisone 2.5mg for an extended period of time.  He was
initially maintained on prednisone and Atrovent nebs.  Dr. [**Last Name (STitle) **]
saw the patient during this admission and stated that the
patient's primary diagnosis may be more likely hypersensitivity
pneumonitis secondary to chronic aspiration, with Parkinson's
disease as a predisposing factor.  Prednisone was d/c'd per
pulmonary recs with the expectation of slight worsening of
respiratory status initially secondary to steroid dependence.
The patient was given additional nebulizer treatments at this
time.  The patient may require home O2.  He is to f/u with Dr.
[**Last Name (STitle) **] as an outpatient for further assessment of his pulmonary
process.
.
MRSA bacteremia/pneumonia- Pneumonia was found on CXR during
this admission, thought to be secondary to aspiration during
arrest.  The patient was initially started on vancomycin,
ceftriaxone and azithromycin for aspiration pneumonia coverage.
Blood and sputum cultures from [**5-29**] were positive for MRSA.
Ceftriaxone and azithromycin were d/c'd.  Vancomycin was
continued for treatment of the MRSA infection.  A PICC line was
placed on [**6-2**] for outpatient completion of a 14 day course of
antibiotics.  He has completed 7 days of treatment on the day of
discharge.
.
Dementia/delirium- Mr. [**Known lastname 21781**] has underlying dementia
secondary to Parkinson's disease.  He became disoriented and
somnolent during this admission, but became more alert when he
received treatment for his bacteremia and pneumonia.  Towards
the end of his hospital stay, he appeared to be experiencing
auditory and visual hallucinations, speaking to and seeing his
wife in his room when she was not present.  New infection was
ruled out.  Further discussion with his family revealed that he
typically experiences some psychosis when he is admitted to the
hospital for an extended period of time.  Sedating medications
were avoided throughout his stay.  He was maintained on his
outpatient dose of Sinemet.  He is to follow up with his
outpatient neurologist, Dr. [**Last Name (STitle) 32878**], for continuation of his
Parkinson's treatment.
.
Dispo- Mr. [**Known lastname 21781**] was discharged to home with services.


Medications on Admission:
Sinemet 25/100 2 tabs at 8AM, 1.5 mg Q 1PM, 1 tab 4PM
Prednisone 2.5 mg QD
Quinidine 324 mg SA [**Hospital1 **]
Simvastatin 20 mg QHS
HCTZ/Spironolactone 25/25 Q MWF
Omeprazole QD

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. Quinidine Gluconate 324 mg Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release(s)* Refills:*2*
5. 0.9% saline 5 mL IV flus SASH and prn
6. Heparin 10 u/mL IV flush - 5 mL SASH and prn
7. Please check BUN, Cr, and Vanco trough level q week
8. Carbidopa-Levodopa 25-100 mg Tablet Sig: One (1) Tablet PO
QPM (once a day (in the evening)).
Disp:*30 Tablet(s)* Refills:*2*
9. Carbidopa-Levodopa 25-100 mg Tablet Sig: Two (2) Tablet PO
QAM (once a day (in the morning)).
Disp:*60 Tablet(s)* Refills:*2*
10. Carbidopa-Levodopa 25-100 mg Tablet Sig: 1.5 Tablets PO QD
().
Disp:*45 Tablet(s)* Refills:*2*
11. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24
hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
12. Vancomycin 5,000 mg Recon Soln Sig: 1250 (1250) mg
Intravenous  twice a day for 7 days: Start date [**5-30**] (duration
14 days).
Disp:*qs qs* Refills:*0*
13. Atrovent HFA 17 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation four times a day as needed for shortness of breath or
wheezing.
Disp:*2 inhalers* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
ventricular tachycardia, non-sustained
diastolic congestive heart failure
chronic respiratory failure
Parkinsonism

Discharge Condition:
stable

Discharge Instructions:
Please call your primary care physician or cardiologist or come
to the emergency room if you have chest pain, shortness of
breath, palpitations, or any other symptom that bothers you.

Followup Instructions:
You have an appointment with your primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) **] ([**Telephone/Fax (1) 49524**], on [**6-6**] at 10:30am.
.
Please follow up with Dr. [**Last Name (STitle) 5543**] (cardiologist) on [**6-15**]
at 2:30pm at the [**Hospital1 **] [**Last Name (Titles) 620**].  Dr. [**Last Name (STitle) 5543**]
is covering for Dr. [**Last Name (STitle) 3321**] while he is on vacation, after
you see Dr. [**Last Name (STitle) 5543**], you should make a follow up appointment
with Dr. [**Last Name (STitle) 3321**].
.
Please follow up with Dr. [**Last Name (STitle) **] (pulmonologist) on [**8-18**]
at 9:30 am in [**Hospital Ward Name 23**] 7.  This is the earliest that you could be
booked for an appointment, the clinic will call you if there are
any cancellations and they can get you in earlier.



Completed by:[**2169-7-19**]
{'Other premature beats,Acute respiratory failure,Bacteremia,Methicillin susceptible pneumonia due to Staphylococcus aureus,Postinflammatory pulmonary fibrosis,Diastolic heart failure, unspecified,Urinary tract infection, site not specified,Infection with microorganisms resistant to penicillins,Paralysis agitans,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}


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: cardiac arrest

PRESENT ILLNESS: 82 M with h/o IPF (on chronic steroids), PVD, h/o VT (on
dofetilide), and P.D.  He was last seen at [**Hospital1 18**]-[**Location (un) 620**]
cardiology clinic [**4-25**] (one month prior to admission).  He was
at home being cared for by his wife, daughter, and nurses and
was noted to be "much improved" but using continual O2 and
having increased SOB in the last few weeks.  He denied chest
discomfort or palpitations but did report occasional
lightheadedness without falls.
.
On the evening of presentation, he was leaving a restaurant
after father's day dinner.  He sat down in the passenger seat,
complained of fatigue, then became acutely SOB; changes in
position did not help these sx.  His family started to drive to
the ED, but the patient passed out, turned blue, and his eyes
rolled back in his head.  He was promptly removed from the car
and received CPR from his daughter who is [**Name8 (MD) **] RN until EMS
arrived when he was noted to be in asystolic arrest.  EMS
administered epi, lido, and atropine and intubated the patient.
He was brought to [**Location (un) 620**] ED where he was in SR w/NSVT.  ECG
demonstrated ST depression in V2-4.  The patient was given
amiodarone for his NSVT which decreased his HR to 100s.  He was
then trasferred to [**Hospital1 18**].  Labs pending at time of transfer
demonstrated Na 141, K 4.3, Cl 103, CO2 22.9, Glucose 123, BUN
21, Creatinine 1.3, Ca 8.8, Mg 2.2, Albumin 3.7, Protein 6.8,
TBili .66, AlkPhos 118, ALT 25, AST 27, CPK 42, INR 1.2, PTT 31,
WBC 9.5, HCT 38.3, MCV 86.6, PLT 201, N59L34M7 and ABG of
7.3/33/155 on CMV550X2 40 5.
...
MEDICATIONS:
Sinemet 25/100 2 tabs at 9:00 a.m., 1.5 tabs 11:00 a.m., 1 tab
4:00 p.m. Prednisone 2.5. Quinaglute 325 q.12 hours. Omeprazole
20 q.a.m.. P.R.N. Colace, Senokot. ASA 81, MVI 1 daily. Zocor on
hold.
...

MEDICAL HISTORY: Past Medical History:
   1. Orthostatic hypotension (? Shy-[**Last Name (un) **]).
   2. Diastolic congestive heart failure.
   3. RMVT (repetitive monomorphic VT presumably from RVOT
origin).
   4. Coronary artery disease/CA calcification.
   5. Dyslipidemia.
   6. Peripheral vascular disease (status amputation right first
toe [**2168-11-23**]).
   7. Pulmonary fibrosis.
   8. Chronic obstructive pulmonary disease.
   9. Parkinsonism with probable Shy-[**Last Name (un) **].
   10. Episodic gout.
   11. Chronic respiratory failure.
   12. Past hypermagnesemia.
   13. Last echo [**2168-7-13**] w/EF 55-60% and 1+ MR

MEDICATION ON ADMISSION: Sinemet 25/100 2 tabs at 8AM, 1.5 mg Q 1PM, 1 tab 4PM
Prednisone 2.5 mg QD
Quinidine 324 mg SA [**Hospital1 **]
Simvastatin 20 mg QHS
HCTZ/Spironolactone 25/25 Q MWF
Omeprazole QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: NC

SOCIAL HISTORY: lives at home with wife, who is HCP. Former [**Name2 (NI) 1818**], quit.
Blueprint shop-->chemical exposures. 

### Response:
{'Other premature beats,Acute respiratory failure,Bacteremia,Methicillin susceptible pneumonia due to Staphylococcus aureus,Postinflammatory pulmonary fibrosis,Diastolic heart failure, unspecified,Urinary tract infection, site not specified,Infection with microorganisms resistant to penicillins,Paralysis agitans,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}
