CHIEF COMPLAINT: s/p PVI c/b post op hypotension and bradycardia

PRESENT ILLNESS: 53 yo male a history of mild Ebstein??????s anomaly, atrial
tachycardia and recently diagnosed atrial fibrillation. He has
had a TEE cardioversion and subsequently discharged.  Then, in
[**2130-11-5**] he ad palpitations again and had another cardioversion,
started on sotalol, but couldn't tolerate due to bradycardia and
was referred in for PVI.  Today, the patient underwent
successful PVI, but postoperatively he was bradycardic to the
high 30s/low 40s, and was hypotensive to the 80s/90s.  He was
given IVF bolus with improvement of his SBP.  The rhythm
appeared to be intermittent junctional bradycardia, thought to
be due to sinus dysfunction post PVI.  At the time of transfer
to the CCU for monitoring, he was hemodynamically stable and
otherwise doing well. He had an ECHO in the PACU which did not
show any pericardial effusion. HCT was stable.  CT
abdomen/pelvis without evidence of RP bleed.
.
On review of systems, he denies deep venous thrombosis,
pulmonary embolism, bleeding at the time of surgery, myalgias,
joint pains, cough, hemoptysis, black stools or red stools. He
denies recent fevers, chills or rigors. He denies exertional
buttock or calf pain. All of the other review of systems were
negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (-)Diabetes, (+)Dyslipidemia,
(-)Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD: cardioversion x 2
3. OTHER PAST MEDICAL HISTORY:
Atrial fibrillation
Atrial tachycardia
Ebstein??????s anomaly
H/O TIA/RIND
Abnormal EKG-sinus brady, RBBB, t wave inversion III, avf
Dyslipidemia
Heart murmur

MEDICATION ON ADMISSION: Lipitor 20mg PO qday
MVI
Lysine 1,000 mg PO qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: denies
-ETOH:  2 drinks/week
-Illicit drugs:  none
Atrial fibrillation,Ebstein's anomaly,Other iatrogenic hypotension,Other and unspecified hyperlipidemia
Atrial fibrillation,Ebstein's anomaly,Iatrogenc hypotnsion NEC,Hyperlipidemia NEC/NOS
Admission Date:  [**2130-12-21**]              Discharge Date:   [**2130-12-22**]

Date of Birth:  [**2077-6-14**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Doctor First Name 1402**]
Chief Complaint:
s/p PVI c/b post op hypotension and bradycardia

Major Surgical or Invasive Procedure:
Pulmonary Vein Isolation


History of Present Illness:
53 yo male a history of mild Ebstein??????s anomaly, atrial
tachycardia and recently diagnosed atrial fibrillation. He has
had a TEE cardioversion and subsequently discharged.  Then, in
[**2130-11-5**] he ad palpitations again and had another cardioversion,
started on sotalol, but couldn't tolerate due to bradycardia and
was referred in for PVI.  Today, the patient underwent
successful PVI, but postoperatively he was bradycardic to the
high 30s/low 40s, and was hypotensive to the 80s/90s.  He was
given IVF bolus with improvement of his SBP.  The rhythm
appeared to be intermittent junctional bradycardia, thought to
be due to sinus dysfunction post PVI.  At the time of transfer
to the CCU for monitoring, he was hemodynamically stable and
otherwise doing well. He had an ECHO in the PACU which did not
show any pericardial effusion. HCT was stable.  CT
abdomen/pelvis without evidence of RP bleed.
.
On review of systems, he denies deep venous thrombosis,
pulmonary embolism, bleeding at the time of surgery, myalgias,
joint pains, cough, hemoptysis, black stools or red stools. He
denies recent fevers, chills or rigors. He denies exertional
buttock or calf pain. All of the other review of systems were
negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

Past Medical History:
1. CARDIAC RISK FACTORS: (-)Diabetes, (+)Dyslipidemia,
(-)Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD: cardioversion x 2
3. OTHER PAST MEDICAL HISTORY:
Atrial fibrillation
Atrial tachycardia
Ebstein??????s anomaly
H/O TIA/RIND
Abnormal EKG-sinus brady, RBBB, t wave inversion III, avf
Dyslipidemia
Heart murmur

Social History:
-Tobacco history: denies
-ETOH:  2 drinks/week
-Illicit drugs:  none

Family History:
No family history of early MI, otherwise non-contributory.

Physical Exam:
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of *** cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

Pertinent Results:
[**2130-12-22**] 04:16AM BLOOD WBC-7.9 RBC-3.81* Hgb-11.9*# Hct-32.3*
MCV-85 MCH-31.3 MCHC-36.9* RDW-13.1 Plt Ct-219
[**2130-12-21**] 07:45AM BLOOD PT-16.2* PTT-25.5 INR(PT)-1.5*
[**2130-12-22**] 04:16AM BLOOD Glucose-109* UreaN-13 Creat-0.8 Na-140
K-3.8 Cl-107 HCO3-28 AnGap-9
.
[**2130-12-20**] CTA Chest: 1. Two left sided and a single, common right
sided pulmonary vein with no evidence of anomalous pulmonary
venous return or focal stenosis (dimensions listed above).
2. Dilated right atrium and right ventricle.
3. Less than 4-mm lung nodules, do not warrant further followup
is the patient has no risk factor for malignancy. If risk
factors are present, followup is recommended in 1 year.
4. Signs of small airway disease.
.
[**2130-12-21**] Echocardiogram: The left atrium is mildly dilated. No
atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%). There is no
ventricular septal defect. The right ventricular cavity is
markedly dilated with normal free wall contractility. The aortic
root is moderately dilated at the sinus level. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic stenosis. Mild (1+) aortic regurgitation
is seen. The mitral valve leaflets are mildly thickened. Trivial
mitral regurgitation is seen. The septal insertion of the
tricuspid valve is apically displaced, consistent with Ebstein's
anomaly. Moderate [2+] tricuspid regurgitation is seen. There is
borderline pulmonary artery systolic hypertension. There is no
pericardial effusion.
IMPRESSION: Mild Ebstein's anomaly with dilated right ventricle
and moderate TR. Normal regional and global left ventricular
systolic function. Mild aortic and moderate tricuspid
regurgitation. No pericardial effusion seen.
.
[**2130-12-21**] CT Abd/Pelvis: 1. No evidence of retroperitoneal
hematoma.
2. Transitional lumbosacral anatomy.

Brief Hospital Course:
The patient was admitted with difficult to control atrial
fibrillation, s/p pulmonary vein isolation with post-operative
bradycardia and hypotension.  Nodal agents were held and no
pressors were needed.  Blood pressures on admission were in the
100s systolic with HR in the 60s.  The patient did well and was
discharged the following day.  He was initially put on a heparin
drip, then started on Coumadin and given Lovenox for a bridge.
He was discharged with follow-up with Dr. [**Last Name (STitle) **] and [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
of Hearts monitor.  He remained in sinus rhythm post-procedure.

Medications on Admission:
Lipitor 20mg PO qday
MVI
Lysine 1,000 mg PO qday

Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Multivitamins     Tablet, Chewable Sig: One (1) Tablet PO
DAILY (Daily).
3. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: at 5
PM.
4. Lysine 1,000 mg Tablet Sig: One (1) Tablet PO once a day.
5. Enoxaparin 80 mg/0.8 mL Syringe Sig: Eighty (80) mg
Subcutaneous [**Hospital1 **] (2 times a day): please use until INR > 2.0.
Disp:*14 syringe* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Atrial fibrillation
Ebstein's anomaly
Dyslipidemia

Discharge Condition:
VS: stable
Groins: stable
Labs: stable


Discharge Instructions:
You were admitted to the hospital to undergo a pulmonary vein
isolation procedure to treat atrial fibrillation.  You has a
short period of low blood pressure and slow heart rate after the
procedure.

No changes were made to your medications, except that you should
take 5 mg of coumadin daily for now while your INR is
subtherapeutic as your coumadin was held for the procedure.

You will need to have your INR checked on Monday, [**12-25**]
and adjust your dose of coumadin for Monday based on the INR.
Continue the Lovenox until your INR is between 2.0 and 3.0

Go to the emergency room or call your primary doctor if you
experience fevers, chills, chest pain, shortness of breath,
dizziness, blood in your stool, or black stool.

Followup Instructions:
An appointment was made for you to follow up with your
cardiologist:
2 weeks - 3 weeks
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2131-1-12**] 1:40
{"Atrial fibrillation,Ebstein's anomaly,Other iatrogenic hypotension,Other and unspecified hyperlipidemia"}


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 PVI c/b post op hypotension and bradycardia

PRESENT ILLNESS: 53 yo male a history of mild Ebstein??????s anomaly, atrial
tachycardia and recently diagnosed atrial fibrillation. He has
had a TEE cardioversion and subsequently discharged.  Then, in
[**2130-11-5**] he ad palpitations again and had another cardioversion,
started on sotalol, but couldn't tolerate due to bradycardia and
was referred in for PVI.  Today, the patient underwent
successful PVI, but postoperatively he was bradycardic to the
high 30s/low 40s, and was hypotensive to the 80s/90s.  He was
given IVF bolus with improvement of his SBP.  The rhythm
appeared to be intermittent junctional bradycardia, thought to
be due to sinus dysfunction post PVI.  At the time of transfer
to the CCU for monitoring, he was hemodynamically stable and
otherwise doing well. He had an ECHO in the PACU which did not
show any pericardial effusion. HCT was stable.  CT
abdomen/pelvis without evidence of RP bleed.
.
On review of systems, he denies deep venous thrombosis,
pulmonary embolism, bleeding at the time of surgery, myalgias,
joint pains, cough, hemoptysis, black stools or red stools. He
denies recent fevers, chills or rigors. He denies exertional
buttock or calf pain. All of the other review of systems were
negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (-)Diabetes, (+)Dyslipidemia,
(-)Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  none
-PACING/ICD: cardioversion x 2
3. OTHER PAST MEDICAL HISTORY:
Atrial fibrillation
Atrial tachycardia
Ebstein??????s anomaly
H/O TIA/RIND
Abnormal EKG-sinus brady, RBBB, t wave inversion III, avf
Dyslipidemia
Heart murmur

MEDICATION ON ADMISSION: Lipitor 20mg PO qday
MVI
Lysine 1,000 mg PO qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: denies
-ETOH:  2 drinks/week
-Illicit drugs:  none 

### Response:
{"Atrial fibrillation,Ebstein's anomaly,Other iatrogenic hypotension,Other and unspecified hyperlipidemia"}
