CHIEF COMPLAINT: tachycardia

PRESENT ILLNESS: 78 year old male with a PMH signfiicant for CLL, BPH,
Cholelithiasis, hematuria, UTI, PUD, and prior upper extremity
DVT who presents with tachycardia.

MEDICAL HISTORY: CLL diagnosed [**2183-10-28**], treated with fludarabine and cytoxan
Upper extremity DVT

MEDICATION ON ADMISSION: Acyclovir 400 mg PO Q8H
Acetaminophen 650 mg PO Q6H:PRN pain
Allopurinol 300 mg PO/NG DAILY
Docusate Sodium 100 mg PO BID
Senna 1 TAB PO/NG [**Hospital1 **]:PRN constipation
Heparin IV per Weight-Based Dosing Guidelines
Sulfameth/Trimethoprim SS 1 TAB PO/NG DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T: 97.8 BP: 117/66 P: 89 R: 19 O2: 94% RA
General: Alert, oriented, no acute distress, cachectic
[**Country 4459**]: Sclera anicteric, mildly dry MM, oropharynx clear
Neck: Thin, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, decreased lung sounds
at the left base, no wheezes, rales, ronchi
CV: Normal rate and regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin:  Warm, dry, multiple skin tags, no breakdown
Neuro:  CN2-12 in tact, no deficits

FAMILY HISTORY: He has 2 daughters who are healthy.

SOCIAL HISTORY: He came to USA from [**Country 532**] 14 yrs ago. Denies alcohol or drug
use but he is smoking for 60 years, now 1-2 packs per day or
tobacco pipe every hour. He used to repair watches.
Dehydration,Other pulmonary embolism and infarction,Chronic lymphoid leukemia, without mention of having achieved remission,Other specified cardiac dysrhythmias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Tobacco use disorder,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of venous thrombosis and embolism,Personal history of irradiation, presenting hazards to health,Long-term (current) use of other medications
Dehydration,Pulm embol/infarct NEC,Ch lym leuk wo achv rmsn,Cardiac dysrhythmias NEC,BPH w/o urinary obs/LUTS,Tobacco use disorder,Cholelithiasis NOS,Hx-ven thrombosis/embols,Hx of irradiation,Long-term use meds NEC
Admission Date:  [**2183-12-2**]              Discharge Date:   [**2183-12-5**]

Date of Birth:  [**2105-1-16**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3963**]
Chief Complaint:
tachycardia


Major Surgical or Invasive Procedure:
None


History of Present Illness:
78 year old male with a PMH signfiicant for CLL, BPH,
Cholelithiasis, hematuria, UTI, PUD, and prior upper extremity
DVT who presents with tachycardia.

Notably, patient has a month-long admission from [**2183-10-28**] -
[**2183-11-29**] for new diagnosis CLL. Patient received both
chemotherapy and radiation during his stay, complicated only by
nausea. He also underwent chest tube placement by interventional
pulmonology which drained fluid consistent with a chylothorax.

The patient was in clinic for a routine follow-up for his CLL
when he was noted to have a heart rate in the 200s and a BP
80/55. An EKG showed SVT; a PIV was palced, and the patient was
given 6 mg adenosine, which reversed the patient into a sinus
rhythm in the 100s. The patient does not have known cardiac or
conduction system disease and was referred to the ED for further
evaluation.

In the ED initial vital signs were 99.5 110 98/55 18 97%. The
patient denied having any chest pain, sob, pleuretic pain. He
says his BP normally is 100s/60s. He has noted that he has been
very nauseaus and vomiting, but attirbutes this to his
chemo/radiation regimen; he did note that his vomitus was very
dark. He denies any personal or family history of clots save for
the one that was discovred around his PICC line during his
admission. He also says that he believes he has gotten all of
his doses of Lovenox, which he was discharged on. A CTA was
performed which showed pulmonary embolism. A CT head was
negative for any mass. Patient was noted to be intermittently
hypotensive inot the 80s with response to fluid bolus. Heparin
gtt was started. Most recent vitals from ED were HR 90, BP
100/58, O2 99% RA. Patient was given 1.5 L IVF in the ED, and
has 3 PIVs (20, 22,and 18 G).


Past Medical History:
CLL diagnosed [**2183-10-28**], treated with fludarabine and cytoxan
Upper extremity DVT


Social History:
He came to USA from [**Country 532**] 14 yrs ago. Denies alcohol or drug
use but he is smoking for 60 years, now 1-2 packs per day or
tobacco pipe every hour. He used to repair watches.


Family History:
He has 2 daughters who are healthy.

Physical Exam:
Vitals: T: 97.8 BP: 117/66 P: 89 R: 19 O2: 94% RA
General: Alert, oriented, no acute distress, cachectic
[**Country 4459**]: Sclera anicteric, mildly dry MM, oropharynx clear
Neck: Thin, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, decreased lung sounds
at the left base, no wheezes, rales, ronchi
CV: Normal rate and regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin:  Warm, dry, multiple skin tags, no breakdown
Neuro:  CN2-12 in tact, no deficits


Pertinent Results:
Admission Labs:
[**2183-12-2**] 03:35PM BLOOD WBC-245.8* RBC-3.64* Hgb-11.0* Hct-33.4*
MCV-92 MCH-30.2 MCHC-32.9 RDW-19.1* Plt Ct-377
[**2183-12-2**] 03:35PM BLOOD Neuts-4* Bands-0 Lymphs-96* Monos-0*
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2183-12-2**] 06:00PM BLOOD PT-14.1* PTT-23.5 INR(PT)-1.2*
[**2183-12-2**] 03:35PM BLOOD Creat-0.7 Na-138 K-3.6 Cl-100
[**2183-12-2**] 03:35PM BLOOD Albumin-3.2*
[**2183-12-2**] 06:00PM BLOOD Calcium-8.0* Phos-2.7 Mg-1.9
[**2183-12-2**] 06:00PM BLOOD CK(CPK)-14*

Discharge Labs:
[**2183-12-5**] 06:15AM BLOOD WBC-187.5* RBC-2.87* Hgb-8.4* Hct-25.8*
MCV-90 MCH-29.4 MCHC-32.7 RDW-19.4* Plt Ct-303
[**2183-12-5**] 06:15AM BLOOD PT-16.3* PTT-33.2 INR(PT)-1.4*
[**2183-12-5**] 06:15AM BLOOD Gran Ct-3750
[**2183-12-5**] 06:15AM BLOOD Glucose-104* UreaN-12 Creat-0.5 Na-134
K-4.3 Cl-101 HCO3-30 AnGap-7*
[**2183-12-5**] 06:15AM BLOOD Calcium-7.5* Phos-2.5* Mg-1.9

Studies:
Cardiology Report ECG Study Date of [**2183-12-2**]  5:45:32 PM
Artifact is present. Sinus tachycardia. Right axis deviation.
Right
bundle-branch block. Low voltage in the limb leads. Compared to
the previous racing of [**2183-10-27**] there is probably no significant
change.

CTA CHEST W&W/O C&RECONS, NON-CORONARY Study Date of [**2183-12-2**]
6:22 PM
IMPRESSION:
1. Pulmonar embolism affecting the right upper apical and right
lower medial and posterior basal subsegments. Findings were
posted emergently to the ED Dashboard, and confirmed with [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 49784**] around 22:00 on [**2183-12-2**].
2. Bilateral pleural effusions, moderate on the left and small
on the right, with underlying atelectasis. Effusions have
significantly decreased from prior.
3. Previously seen posterior mediastinal soft tissue is not well
appreciated on this study, with significant reduction in the
interval.

CT HEAD W/O CONTRAST Study Date of [**2183-12-2**] 8:52 PM
IMPRESSION: No acute intracranial pathology.

BILAT LOWER EXT VEINS Study Date of [**2183-12-3**] 8:03 AM
IMPRESSION: No evidence of DVT in the right or left lower
extremity.


Brief Hospital Course:
78 year old male with a pmh significant for a newly diagnosed
CLL in [**10/2183**], DVT, and found to have PE admitted for
supraventricular tachycardia, PE, and dehydration.

# Dehydration: Likely in the setting of post-treatment nausea
and vomiting. He has had emesis and nausea and been unable to
take good PO at home. It generally occurs at night time, without
a clear etiology. He had a scan of his head which was negative
for any acute process. He was transiently hypotensive with SBPs
in the 80s, with good response to fluid boluses. He had nausea
controlled with compazine in the [**Hospital Unit Name 153**] and on the floor. He was
able to take good PO and had a good appettite and intake by the
time of discharge. He was discharged with anti-emetics to be
taken QHS for nausea.

# PE: He had a CTA on admission to the ED with SVT, and was
found to have a PE. He recently had an upper extremity DVT
diagnosed during his past admission.  He did not have a CTA
after diagnosis of DVT and he had near resolution of his DVT on
discharge. He was discharged home on lovenox 1.5mg/kg daily due
to inability to give himself injections. While admitted he was
monitored in the [**Hospital Unit Name 153**] on a heparin drip and was then converted
to lovenox [**Hospital1 **]. It was not felt that he was a lovenox failure,
and rather the SVT was likely secondary to the significant
dehydration on top of a chronic PE.  We attempted to have him
discharged on lovenox [**Hospital1 **] 1mg/kg dosing, however he did not have
the visual acuity or dexterity to give himself injections. He
also did not have anyone at home to give him an injection. We
investigated the possibility of fundaparinux, however it was
contraindicated in him because of his weight (under 50kg). We
decided to have him discharged on lovenox 1.5mg/kg dosing with
assistance from VNA. He was discharged with follow-up on Monday
[**2183-12-8**], on 7-[**Hospital Ward Name **].

# SVT: Likely in the setting of dehydration from emesis and poor
PO intake. PE may have been a contributing factor. He was 200
BPM and asymptomatic.  He broke with adenosine 6mg x1 in clinic,
prior to being sent to the ED.  During the rest of the admission
he was in sinus rhythm with normal rate or slight tachycardia
(100-105).

# Transfer of care: He was discharged home with VNA for lovenox
injections. He was also discharged with anti-emetics for nausea
QHS. He was set-up with a clinic appointment in 7 [**Hospital **]
clinic on [**2183-12-8**].

Medications on Admission:
Acyclovir 400 mg PO Q8H
Acetaminophen 650 mg PO Q6H:PRN pain
Allopurinol 300 mg PO/NG DAILY
Docusate Sodium 100 mg PO BID
Senna 1 TAB PO/NG [**Hospital1 **]:PRN constipation
Heparin IV per Weight-Based Dosing Guidelines
Sulfameth/Trimethoprim SS 1 TAB PO/NG DAILY


Discharge Medications:
1. allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
3. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day as needed for constipation.
Disp:*62 Capsule(s)* Refills:*0*
5. enoxaparin 80 mg/0.8 mL Syringe Sig: Seventy (70) mg
Subcutaneous once a day for 6 months.
Disp:*30 syringes* Refills:*2*
6. ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO at bedtime.
Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
All Care VNA

Discharge Diagnosis:
Primary:
Pulmonary embolism
Supraventricular tachycardia
Dehydration
Secondary:
CLL


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Mr. [**Known lastname 49783**], it was a pleasure taking part in your care. You
were admitted to [**Hospital1 18**] for a fast heart rate (supraventricular
tachycardia). We gave you a medication called adenosine to help
break the rhtythm, and your heart rate and rhythm went back to
normal.

You were also found to have a blood clot in your lung. We put
you on medication to thin you blood (first heparin then lovenox)
and you did well on this medication.

Finally, you were very dehydrated from nausea and vomiting at
home. We treated the nausea with medication and you were able to
eat food again. We also gave you hydration through an IV.

At the time of discharge you were much improved.

We made the following changes to your medications:
-STARTED Docusate to help with constipation
-STARTED Ondansetron 8mg at bedtime for nausea

Please take your medications as prescribed.

Followup Instructions:
Department: BMT/ONCOLOGY UNIT
When: MONDAY [**2183-12-8**] at 10:30 AM [**Telephone/Fax (1) 447**]
Building: Fd [**Hospital Ward Name 1826**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) 3971**]
Campus: EAST     Best Parking: Main Garage



Completed by:[**2183-12-6**]
{'Dehydration,Other pulmonary embolism and infarction,Chronic lymphoid leukemia, without mention of having achieved remission,Other specified cardiac dysrhythmias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Tobacco use disorder,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of venous thrombosis and embolism,Personal history of irradiation, presenting hazards to health,Long-term (current) use of other medications'}


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: tachycardia

PRESENT ILLNESS: 78 year old male with a PMH signfiicant for CLL, BPH,
Cholelithiasis, hematuria, UTI, PUD, and prior upper extremity
DVT who presents with tachycardia.

MEDICAL HISTORY: CLL diagnosed [**2183-10-28**], treated with fludarabine and cytoxan
Upper extremity DVT

MEDICATION ON ADMISSION: Acyclovir 400 mg PO Q8H
Acetaminophen 650 mg PO Q6H:PRN pain
Allopurinol 300 mg PO/NG DAILY
Docusate Sodium 100 mg PO BID
Senna 1 TAB PO/NG [**Hospital1 **]:PRN constipation
Heparin IV per Weight-Based Dosing Guidelines
Sulfameth/Trimethoprim SS 1 TAB PO/NG DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T: 97.8 BP: 117/66 P: 89 R: 19 O2: 94% RA
General: Alert, oriented, no acute distress, cachectic
[**Country 4459**]: Sclera anicteric, mildly dry MM, oropharynx clear
Neck: Thin, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, decreased lung sounds
at the left base, no wheezes, rales, ronchi
CV: Normal rate and regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin:  Warm, dry, multiple skin tags, no breakdown
Neuro:  CN2-12 in tact, no deficits

FAMILY HISTORY: He has 2 daughters who are healthy.

SOCIAL HISTORY: He came to USA from [**Country 532**] 14 yrs ago. Denies alcohol or drug
use but he is smoking for 60 years, now 1-2 packs per day or
tobacco pipe every hour. He used to repair watches. 

### Response:
{'Dehydration,Other pulmonary embolism and infarction,Chronic lymphoid leukemia, without mention of having achieved remission,Other specified cardiac dysrhythmias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Tobacco use disorder,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Personal history of venous thrombosis and embolism,Personal history of irradiation, presenting hazards to health,Long-term (current) use of other medications'}
