CHIEF COMPLAINT: Ventricluar Tachycardia

PRESENT ILLNESS: Patient is an 84 yo woman w/ h/o CAD s/p MI x 2, HTN,
hyperlipidemia, DM2, OSA who initially presented on [**2143-5-1**] with
c/o chest pain -> on presentation to ED was found to have
monomorphic VT, otherwise hemodynamically stable. Initial EKG
demonstrated STE in V2-V4, which was unchanged from prior.
Patient was given amiodarone load (150mg IV x 2) and was started
on amio gtt, but VT persisted and pt was sedated and
cardioverted with 200J in ED. CP resolved upon cardioversion.
Patient was admitted to [**Hospital Unit Name 196**] service on [**Hospital Ward Name 121**] 3, where she
remained in NSR, no other issues. Her amiodarone was held and
patient went to EP lab today for VT ablation.
In EP lab pt was found to have 3 VT sites, s/p ablation of 1
(ablated presenting VT). Following ablation, pt was found to
have complete heart block and prolonged H-V conduction.
Temporary pacing wire was placed. By end of study, pt was back
to normal conduction, but pacing wire was left in place. Pt was
transferred to CCU for further care.
Currently pt feels well. Denies any CP/pressure, arm pain, SOB,
any other complaints.

MEDICAL HISTORY: CAD s/p MI ([**2115**], [**2120**])
Hypertension
Hyperlipidemia
OSA on BiPap
Diabetes mellitus, type 2
Osteoporosis
Recent shingles
Vertigo

MEDICATION ON ADMISSION: Lisinopril 5 mg PO DAILY
Acetaminophen 325-650 mg PO Q4-6H:PRN
Lorazepam 0.5-1 mg PO HS:PRN
Aspirin 325 mg PO DAILY
Metoprolol 25 mg PO TID
Atorvastatin 40 mg PO DAILY
Oxycodone-Acetaminophen 0.5-1 TAB PO Q4-6H:PRN
Hydrochlorothiazide 25 mg PO DAILY
Insulin SC (per Insulin Flowsheet)

ALLERGIES: Coreg Cr

PHYSICAL EXAM: Vitals - T 96.7, HR 60 (paced), BP 127/57, RR 16, O2 97% on 2L
NC
General - awake, alert, pleasant, lying flat, NAD
HEENT - PERRL, EOMI, MMM
Neck - flat JVP
Chest - R chest wall with bandage/temporary pacer in place.
Looks C/D/I
CVS - RRR soft S1 S2 no noted m/r/g
Lungs - CTA anteriorly, laterally
Abd - soft, large, NT/ND, + BS
Groin - R groin site w/ small amt eccymoses, no hematoma, no
bruit
Ext - No LE edema b/l
.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

FAMILY HISTORY: see above

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use, but history of heavy use - smoked 3pks/day for 30yrs, quit
25yrs ago. There is no history of alcohol abuse. There is no
family history of premature coronary artery disease or sudden
death.
Paroxysmal ventricular tachycardia,Hyposmolality and/or hyponatremia,Thrombocytopenia, unspecified,Atrioventricular block, complete,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia
Parox ventric tachycard,Hyposmolality,Thrombocytopenia NOS,Atriovent block complete,Obstructive sleep apnea,Hypertension NOS,Crnry athrscl natve vssl,Old myocardial infarct,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS
Admission Date:  [**2143-5-1**]              Discharge Date:   [**2143-5-7**]


Service: MEDICINE

Allergies:
Coreg Cr

Attending:[**First Name3 (LF) 2962**]
Chief Complaint:
Ventricluar Tachycardia

Major Surgical or Invasive Procedure:
VT ablation


History of Present Illness:
Patient is an 84 yo woman w/ h/o CAD s/p MI x 2, HTN,
hyperlipidemia, DM2, OSA who initially presented on [**2143-5-1**] with
c/o chest pain -> on presentation to ED was found to have
monomorphic VT, otherwise hemodynamically stable. Initial EKG
demonstrated STE in V2-V4, which was unchanged from prior.
Patient was given amiodarone load (150mg IV x 2) and was started
on amio gtt, but VT persisted and pt was sedated and
cardioverted with 200J in ED. CP resolved upon cardioversion.
Patient was admitted to [**Hospital Unit Name 196**] service on [**Hospital Ward Name 121**] 3, where she
remained in NSR, no other issues. Her amiodarone was held and
patient went to EP lab today for VT ablation.
In EP lab pt was found to have 3 VT sites, s/p ablation of 1
(ablated presenting VT). Following ablation, pt was found to
have complete heart block and prolonged H-V conduction.
Temporary pacing wire was placed. By end of study, pt was back
to normal conduction, but pacing wire was left in place. Pt was
transferred to CCU for further care.
Currently pt feels well. Denies any CP/pressure, arm pain, SOB,
any other complaints.


Past Medical History:
CAD s/p MI ([**2115**], [**2120**])
Hypertension
Hyperlipidemia
OSA on BiPap
Diabetes mellitus, type 2
Osteoporosis
Recent shingles
Vertigo


Social History:
Social history is significant for the absence of current tobacco
use, but history of heavy use - smoked 3pks/day for 30yrs, quit
25yrs ago. There is no history of alcohol abuse. There is no
family history of premature coronary artery disease or sudden
death.

Family History:
see above

Physical Exam:
Vitals - T 96.7, HR 60 (paced), BP 127/57, RR 16, O2 97% on 2L
NC
General - awake, alert, pleasant, lying flat, NAD
HEENT - PERRL, EOMI, MMM
Neck - flat JVP
Chest - R chest wall with bandage/temporary pacer in place.
Looks C/D/I
CVS - RRR soft S1 S2 no noted m/r/g
Lungs - CTA anteriorly, laterally
Abd - soft, large, NT/ND, + BS
Groin - R groin site w/ small amt eccymoses, no hematoma, no
bruit
Ext - No LE edema b/l
.
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:
ECHOCARDIOGRAM:
.
The left atrium is normal in size. The estimated right atrial
pressure is
11-15mmHg. There is mild symmetric left ventricular hypertrophy.
The left
ventricular cavity size is normal. Overall left ventricular
systolic function
is severely depressed (ejection fraction 30 percent) secondary
to severe
hypokinesis of all segments except the basal inferior,
posterior, and lateral
walls (the anterior septum is extensively scarred/fibrotic and
akinetic); the
apex is dyskinetic. There is no ventricular septal defect. Right
ventricular
chamber size and free wall motion are normal. The ascending
aorta is mildly
dilated. The aortic valve leaflets (3) are mildly thickened but
aortic
stenosis is not present. Trace aortic regurgitation is seen. The
mitral valve
leaflets are mildly thickened. Mild to moderate ([**11-27**]+) mitral
regurgitation is
seen. There is moderate pulmonary artery systolic hypertension.
There is no
pericardial effusion.
.
.


Brief Hospital Course:
84 year old female with CAD s/p MI, HTN, hyperlipidemia, DM2
presents with chest pain, found to be in hemodynamically stable
monomorphic VT, s/p successful DCCV in ED, now s/p EP study with
VT ablation.  CCU course by problem:
.
# Cardiac:
A. Rhythm: Pt presented in hemodynamically stable monomorphic VT
treated with amio load and gtt and successfully cardioverted
with 200J. Etiology of VT is likely scar from MI in [**2120**] and not
related to new ischemia as it was monomorphic and patient's
clinical history does not support ischemia. Pt remained stable
in NSR on floor.
She went to the EP lab on [**5-3**].  There she underwent a VT
ablation.  Three morphologies of VT were noted although only one
was consistent with the presenting rhythm.  She transiently went
into complete heart block during the procedure and was noted to
have an H-V conduction time of 140msec.  A temporary pacer was
placed.  Initially it was set to VVI 80 but then turned down to
VVI 40.  She did not rely on the pacer for conduction of sinus.
She was in normal sinus or sinus brady during her CCU stay.  We
continued metoprolol and also amio loaded with 400mg [**Hospital1 **].  She
returned to the EP lab on [**5-6**] for a study to assess her H-V
conduction.  It showed HV conduction of 55.  Her temp wire was
pulled and a permanent pacer was not placed.

B. CAD: Pt w/ h/o CAD s/p MI x 2 in [**2115**]/85. Presented with CP
which resolved once converted out of VT. No real signs/sxs of
ischemic event - pt with slightly elevated CK and trop, but in
setting of cardioversion. We continued her cardiac meds.  She
did not have CP while in the CCU

C. Pump: Pt w/ ECHO on [**2143-5-2**] that demonstrates EF of 30%.
Oxygenating well. Appeared euvolemic. We continued her ACEi and
BB
.
# Hyponatremia: Na 127 on admission, Stayed low-normal. Old
records show baseline Na 130-133.
.
# Hypertension:  Continued outpatient meds
.
# Hyperlipidemia: continued statin.
.
# Type 2 DM:  QID FS with RISS.  held oral hypogylcemics.
.
# OSA.  Continued with BiPAP per routine
.
# Code: discussed at length.  patient wanted to be DNR DNI.

Medications on Admission:
Lisinopril 5 mg PO DAILY
Acetaminophen 325-650 mg PO Q4-6H:PRN
Lorazepam 0.5-1 mg PO HS:PRN
Aspirin 325 mg PO DAILY
Metoprolol 25 mg PO TID
Atorvastatin 40 mg PO DAILY
Oxycodone-Acetaminophen 0.5-1 TAB PO Q4-6H:PRN
Hydrochlorothiazide 25 mg PO DAILY
Insulin SC (per Insulin Flowsheet)


Discharge Medications:
1. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
5. Avandia 2 mg Tablet Sig: One (1) Tablet PO once a day.
6. Fosamax 70 mg Tablet Sig: One (1) Tablet PO once a week.
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
10. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed.
Disp:*30 Tablet(s)* Refills:*0*
11. Glucovance 5-500 mg Tablet Sig: Three (3) Tablet PO once a
day: Take 2 tablets in the AM and 1 tablet in the PM.
Disp:*90 Tablet(s)* Refills:*2*
12. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO twice a day:
Take 400mg po twice daily x 2 days.
Take 400mg po Once daily thereafter.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Monomorphic ventricular tachycardia
CAD s/p MI
Hypertension
Anemia of chronic disease


Discharge Condition:
Stable.


Discharge Instructions:
You were admitted with a cardiac arrhythmia.  You underwent
cardioversion to a normal rhythm.  It is felt that this rhythm
is likely due to old scar in your heart from heart attacks in
the past.  You had a procedure called VT ablation to try to
remove the focus of arrhythmis.

Please take all medications as prescribed.

If you have any further arm pain, chest pain, shortness of
breath, palpitations, lightheadedness, or pass out please call
your doctor immediately.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] within the next two weeks
following discharge.  His phone number is [**0-0-**].

Please follow up with your regular doctor as needed.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2964**] MD, [**MD Number(3) 2965**]

Completed by:[**2143-5-7**]
{'Paroxysmal ventricular tachycardia,Hyposmolality and/or hyponatremia,Thrombocytopenia, unspecified,Atrioventricular block, complete,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: Ventricluar Tachycardia

PRESENT ILLNESS: Patient is an 84 yo woman w/ h/o CAD s/p MI x 2, HTN,
hyperlipidemia, DM2, OSA who initially presented on [**2143-5-1**] with
c/o chest pain -> on presentation to ED was found to have
monomorphic VT, otherwise hemodynamically stable. Initial EKG
demonstrated STE in V2-V4, which was unchanged from prior.
Patient was given amiodarone load (150mg IV x 2) and was started
on amio gtt, but VT persisted and pt was sedated and
cardioverted with 200J in ED. CP resolved upon cardioversion.
Patient was admitted to [**Hospital Unit Name 196**] service on [**Hospital Ward Name 121**] 3, where she
remained in NSR, no other issues. Her amiodarone was held and
patient went to EP lab today for VT ablation.
In EP lab pt was found to have 3 VT sites, s/p ablation of 1
(ablated presenting VT). Following ablation, pt was found to
have complete heart block and prolonged H-V conduction.
Temporary pacing wire was placed. By end of study, pt was back
to normal conduction, but pacing wire was left in place. Pt was
transferred to CCU for further care.
Currently pt feels well. Denies any CP/pressure, arm pain, SOB,
any other complaints.

MEDICAL HISTORY: CAD s/p MI ([**2115**], [**2120**])
Hypertension
Hyperlipidemia
OSA on BiPap
Diabetes mellitus, type 2
Osteoporosis
Recent shingles
Vertigo

MEDICATION ON ADMISSION: Lisinopril 5 mg PO DAILY
Acetaminophen 325-650 mg PO Q4-6H:PRN
Lorazepam 0.5-1 mg PO HS:PRN
Aspirin 325 mg PO DAILY
Metoprolol 25 mg PO TID
Atorvastatin 40 mg PO DAILY
Oxycodone-Acetaminophen 0.5-1 TAB PO Q4-6H:PRN
Hydrochlorothiazide 25 mg PO DAILY
Insulin SC (per Insulin Flowsheet)

ALLERGIES: Coreg Cr

PHYSICAL EXAM: Vitals - T 96.7, HR 60 (paced), BP 127/57, RR 16, O2 97% on 2L
NC
General - awake, alert, pleasant, lying flat, NAD
HEENT - PERRL, EOMI, MMM
Neck - flat JVP
Chest - R chest wall with bandage/temporary pacer in place.
Looks C/D/I
CVS - RRR soft S1 S2 no noted m/r/g
Lungs - CTA anteriorly, laterally
Abd - soft, large, NT/ND, + BS
Groin - R groin site w/ small amt eccymoses, no hematoma, no
bruit
Ext - No LE edema b/l
.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

FAMILY HISTORY: see above

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use, but history of heavy use - smoked 3pks/day for 30yrs, quit
25yrs ago. There is no history of alcohol abuse. There is no
family history of premature coronary artery disease or sudden
death. 

### Response:
{'Paroxysmal ventricular tachycardia,Hyposmolality and/or hyponatremia,Thrombocytopenia, unspecified,Atrioventricular block, complete,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}
