CHIEF COMPLAINT: Cardiac Arrest

PRESENT ILLNESS: Ms. [**Known lastname **] is a 52 y/o schoolteacher w/ HTN admitted to CCU s/p
cardiac arrest while walking into school this AM. Per report,
CPR was initiated by her co-workers. When EMS arrived she was
found pulseless and apneic and one shock was delivered. She was
then found to be breathing at a RR of 10 with a rapid pulse, but
was still unresponsive. She was bolused 100 mg of lidocaine IO.
Cardiac monitor per EMS report showed sinus tach at rate of 140
with a BP of 150/100. Patient then became responsive. Lidocaine
infusion at 1 mg/min was started. She was transferred to [**Hospital1 18**]
ED for further management.
In the ED, intial VS: Temp: 98.6 HR: 115 BP:147/92. The
lidocaine gtt was stopped. She was given 50 mg of fentanyl and 4
mg of zofran for chest pain and nausea.
The patient states she felt herself "blackout" immediately
before the arrest and remembered nothing else. She denies
pre-syncope, syncope, palpitations, chest pain or sob. She has
had atypical exertional chest pain since [**Month (only) 116**] of this year,
having severe neck pain radiating to shoulders in the morning
during light exertion, lasting less than 5 minutes. She had a
stress test which was equivical and subsequently had a cardiac
cath at [**Hospital1 2025**] which was normal per patient. She admits to the
sensation this morning, prior to her arrest.
.
In the ED she was seen by the EP service who placed ICD for
secondary prevention. She was then transferred to CCU for
further monitoring.

MEDICAL HISTORY: .
PAST MEDICAL HISTORY:
Hypertension
.
PAST SURGICAL HISTORY:
3 C-Sections
Appendectomy

MEDICATION ON ADMISSION: Diltiazem ER 240 mg Daily (did not take this AM)

ALLERGIES: Lisinopril / Ampicillin

PHYSICAL EXAM: ADmission Exam:
Gen: Pleasant, calm
HEENT: No conjunctival pallor. No icterus. MMM. OP clear.
Flushed face.
NECK: Supple, No LAD. JVP low.
CV: PMI in 5th intercostal space, mid clavicular line. Regular
and tachycardic. normal S1,S2. No murmurs, rubs, clicks, or
[**Last Name (un) 549**]
LUNGS: CTAB. No wheezes, rales, or rhonchi.
ABD: NABS. Soft, NT, ND. No HSM.
EXT: WWP, NO CCE. Full distal pulses bilaterally.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. CN 2-12 grossly intact. Preserved sensation
throughout. 5/5 strength throughout. Normal coordination. Gait
assessment deferred

FAMILY HISTORY: Mother: Died of heart failure at age of 52 secondary to a
"virus". No history of arrythmias, syncope, or sudden death in
the family.

SOCIAL HISTORY: 4th grade teacher, remote smoking history. Quit 25 years ago,
smoking [**12-14**] ppd for 5-10 years. Drinks [**12-14**] glasses of wine per
week. Denies drug use.
Coronary atherosclerosis of native coronary artery,Acute and subacute necrosis of liver,Ventricular fibrillation,Unspecified essential hypertension,Other chronic nonalcoholic liver disease,Other chest pain,Anemia, unspecified,Personal history of tobacco use
Crnry athrscl natve vssl,Acute necrosis of liver,Ventricular fibrillation,Hypertension NOS,Chronic liver dis NEC,Chest pain NEC,Anemia NOS,History of tobacco use
Admission Date:  [**2183-10-22**]              Discharge Date:   [**2183-10-25**]

Date of Birth:  [**2130-12-14**]             Sex:   F

Service: MEDICINE

Allergies:
Lisinopril / Ampicillin

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
Cardiac Arrest

Major Surgical or Invasive Procedure:
Cardiac Catheterization

History of Present Illness:
Ms. [**Known lastname **] is a 52 y/o schoolteacher w/ HTN admitted to CCU s/p
cardiac arrest while walking into school this AM. Per report,
CPR was initiated by her co-workers. When EMS arrived she was
found pulseless and apneic and one shock was delivered. She was
then found to be breathing at a RR of 10 with a rapid pulse, but
was still unresponsive. She was bolused 100 mg of lidocaine IO.
Cardiac monitor per EMS report showed sinus tach at rate of 140
with a BP of 150/100. Patient then became responsive. Lidocaine
infusion at 1 mg/min was started. She was transferred to [**Hospital1 18**]
ED for further management.
In the ED, intial VS: Temp: 98.6 HR: 115 BP:147/92. The
lidocaine gtt was stopped. She was given 50 mg of fentanyl and 4
mg of zofran for chest pain and nausea.
The patient states she felt herself "blackout" immediately
before the arrest and remembered nothing else. She denies
pre-syncope, syncope, palpitations, chest pain or sob. She has
had atypical exertional chest pain since [**Month (only) 116**] of this year,
having severe neck pain radiating to shoulders in the morning
during light exertion, lasting less than 5 minutes. She had a
stress test which was equivical and subsequently had a cardiac
cath at [**Hospital1 2025**] which was normal per patient. She admits to the
sensation this morning, prior to her arrest.
.
In the ED she was seen by the EP service who placed ICD for
secondary prevention. She was then transferred to CCU for
further monitoring.


Past Medical History:
.
PAST MEDICAL HISTORY:
Hypertension
.
PAST SURGICAL HISTORY:
3 C-Sections
Appendectomy


Social History:
4th grade teacher, remote smoking history. Quit 25 years ago,
smoking [**12-14**] ppd for 5-10 years. Drinks [**12-14**] glasses of wine per
week. Denies drug use.

Family History:
 Mother: Died of heart failure at age of 52 secondary to a
"virus". No history of arrythmias, syncope, or sudden death in
the family.

Physical Exam:
ADmission Exam:
Gen: Pleasant, calm
HEENT: No conjunctival pallor. No icterus. MMM. OP clear.
Flushed face.
NECK: Supple, No LAD. JVP low.
CV: PMI in 5th intercostal space, mid clavicular line. Regular
and tachycardic. normal S1,S2. No murmurs, rubs, clicks, or
[**Last Name (un) 549**]
LUNGS: CTAB. No wheezes, rales, or rhonchi.
ABD: NABS. Soft, NT, ND. No HSM.
EXT: WWP, NO CCE. Full distal pulses bilaterally.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. CN 2-12 grossly intact. Preserved sensation
throughout. 5/5 strength throughout. Normal coordination. Gait
assessment deferred


Pertinent Results:
[**2183-10-22**] 08:50AM   cTropnT-<0.01
[**2183-10-22**] 11:15PM   CK-MB-5
[**2183-10-22**] 11:15PM   CK(CPK)-221*

[**10-22**] echo: The left atrium is normal in size. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is borderline
pulmonary artery systolic hypertension. There is no pericardial
effusion.


Brief Hospital Course:
52 yo Female with h/o HTN, who is admitted for cardiac arrest.

#. Cardiac Arrest: Pt received one shock in the field suggestive
of VF or VT rhythm. Cardiac cath showed 80% LAD occlusion which
was the culprit lesion, s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) **]. Echo revealed preserved
cardiac function. EP followed patient, decision was made not to
place ICD since the LAD occlusion was the source of the cardiac
arrest.
.
#. CAD: Pt with 80% occlusions of LAD s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) **]. This LAD
lesion was 20% in [**5-/2183**] at [**Hospital1 2025**] cardiac cath. Pt was started on
medical management for CAD. Metoprolol, atorvastatin, ASA 325mg,
plavix, [**Last Name (un) **] was started in lieu of ACE-I secondary to allergy.
Her lipid panel revealed TAG 154, HDL 50, LDL 104. Started on
atorvastatin 80mg daily Her HbA1c was pending at time of
discharge.
.
# HTN: Held home dilt. Started metoprolol 25mg [**Hospital1 **] and will go
home on metoprolol.
.
#LFTs: Pts LFTs were found to be elevated (400s ALT, 200s AST).
They trended down mildly. Differential included components of
shock liver in setting of cardiac arrest versus underlying
chronic transaminits (possible NASH). Patient should follow this
up outpatient.
.
#Chest Pain: Pt had chest pain from chest compressions and
likely underlying rib fx. CXR was neg for obvious fractures. Pt
was treated with narcotics and tramadol for pain which
controlled symtoms.

Pt will go home with VNA services


Medications on Admission:
Diltiazem ER 240 mg Daily (did not take this AM)

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:*3*
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*3*
3. valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*3*
4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. metoprolol succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*3*
6. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain for 6 days.
Disp:*36 Tablet(s)* Refills:*0*
7. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
8. Senna Concentrate 8.6 mg Tablet Sig: One (1) Tablet PO twice
a day as needed for constipation for 7 days.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Cardiac Arrest
Left Anterior Descending Artery occlusion status post Drug
eluting stent
Coronary artery disease


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


Discharge Instructions:
It was a pleasure to take care of you during this
hospitalization. You were admitted to the hospital for cardiac
arrest. Essentially, your heart was beating in a bad rhythm and
not pumping blood forward. You were found to have a clogged
artery going to your heart which explained why you went into
cardiac arrest. The artery was opened with a stent. You were
started on several new medications to protect your heart. It is
very important to take these medications every day. You also had
chest pain which was attributed to rib fractures from chest
compressions during CPR. This is treated with rest and pain
medications.

Please follow  up with your primary care doctor at the
appointment below. It is also important to follow up with a
cardiologist.

Please refrain from strenuous activity for one week. Follow up
with your cardiologist.

The following changes were made to your medications:

STOP Diltiazem

START:
Atorvastatin 80mg daily
Clopidogrel 75 mg daily
Metoprolol Succinate 50mg daily
Valsartan 80mg daily
Ultram 50mg every 6 hours as needed for pain
Ibuprofen 400mg every 8 hours as needed for pain


Followup Instructions:
Primary care doctor Appointment- Monday, [**2183-10-27**] at 8:45 AM
Name: [**Last Name (LF) **],[**First Name3 (LF) 640**] A
Location: [**Hospital3 **] PRIMARY CARE
Address: [**2183**] STE 441WHITE, NEWON,[**Numeric Identifier 42001**]
Phone: [**Telephone/Fax (1) 9386**]

Cardiologist appointment: Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **], [**11-4**] at
2:40pm.
[**Location (un) 830**], Sharpio 7
[**Location (un) 86**], [**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 62**]
{'Coronary atherosclerosis of native coronary artery,Acute and subacute necrosis of liver,Ventricular fibrillation,Unspecified essential hypertension,Other chronic nonalcoholic liver disease,Other chest pain,Anemia, unspecified,Personal history of tobacco use'}


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: Ms. [**Known lastname **] is a 52 y/o schoolteacher w/ HTN admitted to CCU s/p
cardiac arrest while walking into school this AM. Per report,
CPR was initiated by her co-workers. When EMS arrived she was
found pulseless and apneic and one shock was delivered. She was
then found to be breathing at a RR of 10 with a rapid pulse, but
was still unresponsive. She was bolused 100 mg of lidocaine IO.
Cardiac monitor per EMS report showed sinus tach at rate of 140
with a BP of 150/100. Patient then became responsive. Lidocaine
infusion at 1 mg/min was started. She was transferred to [**Hospital1 18**]
ED for further management.
In the ED, intial VS: Temp: 98.6 HR: 115 BP:147/92. The
lidocaine gtt was stopped. She was given 50 mg of fentanyl and 4
mg of zofran for chest pain and nausea.
The patient states she felt herself "blackout" immediately
before the arrest and remembered nothing else. She denies
pre-syncope, syncope, palpitations, chest pain or sob. She has
had atypical exertional chest pain since [**Month (only) 116**] of this year,
having severe neck pain radiating to shoulders in the morning
during light exertion, lasting less than 5 minutes. She had a
stress test which was equivical and subsequently had a cardiac
cath at [**Hospital1 2025**] which was normal per patient. She admits to the
sensation this morning, prior to her arrest.
.
In the ED she was seen by the EP service who placed ICD for
secondary prevention. She was then transferred to CCU for
further monitoring.

MEDICAL HISTORY: .
PAST MEDICAL HISTORY:
Hypertension
.
PAST SURGICAL HISTORY:
3 C-Sections
Appendectomy

MEDICATION ON ADMISSION: Diltiazem ER 240 mg Daily (did not take this AM)

ALLERGIES: Lisinopril / Ampicillin

PHYSICAL EXAM: ADmission Exam:
Gen: Pleasant, calm
HEENT: No conjunctival pallor. No icterus. MMM. OP clear.
Flushed face.
NECK: Supple, No LAD. JVP low.
CV: PMI in 5th intercostal space, mid clavicular line. Regular
and tachycardic. normal S1,S2. No murmurs, rubs, clicks, or
[**Last Name (un) 549**]
LUNGS: CTAB. No wheezes, rales, or rhonchi.
ABD: NABS. Soft, NT, ND. No HSM.
EXT: WWP, NO CCE. Full distal pulses bilaterally.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. CN 2-12 grossly intact. Preserved sensation
throughout. 5/5 strength throughout. Normal coordination. Gait
assessment deferred

FAMILY HISTORY: Mother: Died of heart failure at age of 52 secondary to a
"virus". No history of arrythmias, syncope, or sudden death in
the family.

SOCIAL HISTORY: 4th grade teacher, remote smoking history. Quit 25 years ago,
smoking [**12-14**] ppd for 5-10 years. Drinks [**12-14**] glasses of wine per
week. Denies drug use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute and subacute necrosis of liver,Ventricular fibrillation,Unspecified essential hypertension,Other chronic nonalcoholic liver disease,Other chest pain,Anemia, unspecified,Personal history of tobacco use'}
