CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 75-year-old male with
past medical history of coronary artery disease status post
three vessel CABG in [**2156**].  He had a LIMA to the LAD,
saphenous vein graft to the PDA, and saphenous vein graft to
OM-1.  This was stented four years ago, congestive heart
failure with an ejection fraction of 25%, chronic renal
insufficiency, and left bundle branch block, who presented to
the Emergency Room after an episode of bradycardia with his
heart rate in the 30s, and was found to have 2:1 heart block.

MEDICAL HISTORY: 1. Coronary artery disease status post myocardial infarction
and coronary artery bypass graft in [**2156**].
2. Congestive heart failure with an ejection fraction of
20-25%.
3. Gout.
4. Hypertension, normal runs 116/60.
5. Prostate cancer status post XRT and hormone therapy.
6. Obese.
7. Ocular melanoma in his left eye status post proton-beam
therapy.
8. Chronic renal insufficiency.
9. Cholecystectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: He has an allergy to contrast dye years ago when
he had his cholecystectomy.  Since then, he has received
contrast and had no adverse reactions.

PHYSICAL EXAM: 

FAMILY HISTORY: His father died at 68 of "cardiac causes."

SOCIAL HISTORY: He is married with two children.  He has
social alcohol use in his teen years.  No recent alcohol use,
no tobacco smoking.
Other second degree atrioventricular block,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dermatophytosis of the body,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Old myocardial infarction
Av block-2nd degree NEC,CHF NOS,Chr blood loss anemia,Dermatophytosis of body,Crnry athrscl natve vssl,Aortocoronary bypass,Old myocardial infarct
Admission Date:  [**2161-9-18**]     Discharge Date:  [**2161-9-22**]

Date of Birth:   [**2085-4-1**]     Sex:  M

Service:  MEDICINE CCU

HISTORY OF PRESENT ILLNESS:  This is a 75-year-old male with
past medical history of coronary artery disease status post
three vessel CABG in [**2156**].  He had a LIMA to the LAD,
saphenous vein graft to the PDA, and saphenous vein graft to
OM-1.  This was stented four years ago, congestive heart
failure with an ejection fraction of 25%, chronic renal
insufficiency, and left bundle branch block, who presented to
the Emergency Room after an episode of bradycardia with his
heart rate in the 30s, and was found to have 2:1 heart block.

The patient states that he had been well until today.  He
exercised on a treadmill 30 minutes every 3-4 days.  The
morning of admission he noted some blurry vision, some
nausea, vomiting and dizziness.  He rested and the symptoms
resolved.  Later in the morning he had three further episodes
of lightheadedness with standing, but no syncope.  He had
taken his blood pressure and it was 116/60 with a heart rate
of 35.  He called his PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], who had told him to go
to the Emergency Room.

The patient denied any chest pain, shortness of breath,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
increasing edema, or palpitations.  He has had a history of
syncopal episode in [**2161-12-12**], after which he was
admitted to [**Hospital **] Hospital.  All of his cardiac workup had
been negative.  He did have a stress test at that time, and a
24 hour Holter monitor, which did not show an explanation for
his syncope.  The patient has not recently had any medication
changes or any new medications added to his regimen.

REVIEW OF SYSTEMS:  He has no other complaints.  No numbness
or tingling, no loss of bowel or bladder continence.  No
fever or chills.  No abdominal pain.  No recent insect bites.

In the Emergency Room, he had a right IJ placed through which
a temporary wire was placed, and he was VVI paced at 50 with
a threshold of 0.5 to 1 milliamps.

PAST MEDICAL HISTORY:
1. Coronary artery disease status post myocardial infarction
and coronary artery bypass graft in [**2156**].
2. Congestive heart failure with an ejection fraction of
20-25%.
3. Gout.
4. Hypertension, normal runs 116/60.
5. Prostate cancer status post XRT and hormone therapy.
6. Obese.
7. Ocular melanoma in his left eye status post proton-beam
therapy.
8. Chronic renal insufficiency.
9. Cholecystectomy.

MEDICATIONS:
1. Aspirin 325 q day.
2. Zestril 20 q day.
3. Metoprolol 50 [**Hospital1 **].
4. Lipitor 20 q day.
5. Terazosin 2 mg q hs.
6. Folic acid.
7. Flonase nasal spray.
8. [**Doctor First Name **] 60 q day.
9. Allopurinol 100 q day.
10. Zantac.

ALLERGIES:  He has an allergy to contrast dye years ago when
he had his cholecystectomy.  Since then, he has received
contrast and had no adverse reactions.

SOCIAL HISTORY:  He is married with two children.  He has
social alcohol use in his teen years.  No recent alcohol use,
no tobacco smoking.

FAMILY HISTORY:  His father died at 68 of "cardiac causes."

PHYSICAL EXAMINATION:  Vital signs in the Emergency Room, he
was afebrile.  His temperature was 97.5, blood pressure
125/47, heart rate of 50, which was ventricular paced, sating
96% on room air.  In general, he was an elderly white male
sleeping comfortably in bed in no apparent distress.  HEENT:
Pupils are equal, round, and reactive to light and
accommodation.  Extraocular movements are intact.  Sclerae
are anicteric.  Cardiovascular:  Regular, rate, and rhythm,
normal S1, S2.  No murmurs, rubs, or gallops.  No jugular
venous distention, no carotid bruits.  Respiratory:  Lungs
are clear to auscultation bilaterally.  Abdomen is soft,
nontender, nondistended, bowel sounds are present, no masses,
guarding, or rebound tenderness, no hepatosplenomegaly.
Extremities:  No cyanosis, clubbing, or edema.  He did have
an area of 3 x 2 erythematous lesion on his left shin, which
looked like a tinea infection.

LABORATORIES ON ADMISSION:  His white count was 6.6,
hematocrit was 29.4, which was down from his baseline of 34.
His Chem-7 was within normal limits.  His CPK was 99,
troponin was negative.

STUDIES:  Electrocardiogram on admission at 4:16 showed 2:1
heart block with an atrial rate of 70, ventricular rate of 35
consistent with second degree A-V delay type two.  He also
has an underlying left bundle branch block with a P-R
interval of 320.

Electrocardiogram at 18:17 just showed paced rhythm, heart
rate of 50.  The patient was admitted to Medicine to the CCU
service.

HOSPITAL COURSE BY SYSTEMS:
1. Cardiovascularly:  For coronary arteries, he was continued
on his aspirin, Lipitor, and ACE inhibitor.  His beta blocker
was held given the risk of complete heart block and his heart
rate being in the low 50's.  His cardiac enzymes were cycled
and they were all negative.

Of note, the date after admission, his electrocardiogram was
consistent with complete heart block.  Otherwise throughout
his hospital stay, he was V-paced.  The patient was awaiting
permanent pacemaker placement on [**Last Name (LF) 766**], [**First Name3 (LF) **] the temporary
pacemaker wire was left in until he had his permanent
pacemaker.

Myocardium:  The patient's ejection fraction was 20-25%.
This was unchanged.  He was continued on his current medical
management as he had no signs or symptoms of congestive heart
failure at this time.

The patient was started on the 11th on cefazolin 1 gram q8 x6
doses prior to pacemaker placement.  On the afternoon of the
11th, the pacemaker was placed without event.  The patient
was started on Vancomycin 1 gram q12h x4 doses.  Chest x-ray
post pacemaker placement showed the leads in good position.

2. Heme:  The patient's hematocrit had decreased from his
baseline.  A repeat hematocrit showed the hematocrit to be
28.5.  Stool guaiac was done and it was negative, yet it was
felt to be anemia secondary to blood loss, and the patient
was transfused 1 unit.  After the 1 unit, the patient's
hematocrit remained stable throughout his hospital course.

3. Renal:  The patient has chronic renal insufficiency.  His
hematocrit was at his baseline.  His ACE inhibitor was
continued as he was medically stable on this regimen.

4. Pulmonary wise:  The patient took fluticasone and Atrovent
as an outpatient, so he was continued on is outpatient
inhalers.

5. Rheum:  The patient has a history of gout.  He was
continued on his Allopurinol.

6. Allergy:  He has seasonal rhinitis.  He was continued on
his [**Doctor First Name **].

7. Prostate cancer status post XRT and hormone therapy:  He
was continued on his terazosin.

8. Infectious disease/tinea:  The patient was started on
Lamisil cream [**Hospital1 **].

9. Fluids, electrolytes, and nutrition:  The patient did have
some magnesium replaced on the 11th, and the patient was in
stable condition throughout his hospital course.  He was
discharged home the day after pacemaker placement.  He
remained afebrile throughout his hospital course and had no
events overnight on telemetry.

DISCHARGE INSTRUCTIONS:  If he experienced any symptoms prior
to those he experienced before his pacemaker was placed,
had been given an instructions book about pacemakers, and if
he were to have any questions he was given the number from
the pacemaker clinic.  He is to take all of his regular
medicines per his normal routine except for the metoprolol.

He was discharged with Percocet for pain.  He is to take one
tablet every 4-6 hours prn as needed.  He was to continue
using the cream for his rash for seven days.  If this did not
clear in seven days, to contact his PCP or dermatologist.  He
was being discharged on a three day course of Keflex.  He was
instructed to take one tablet po four times a day for three
days and to take all pills.

FINAL DIAGNOSIS:
1. Status post pacemaker placement.
2. Complete heart block.
3. Coronary artery disease status post coronary artery bypass
graft.
4. Congestive heart failure.
5. Gout.
6. Tinea infection.
7. Prostate cancer.
8. Chronic renal insufficiency.

RECOMMENDED FOLLOWUP:  Follow up at your [**Hospital **] Clinic
within the next week and call for the appointment.

MAJOR SURGICAL OR INVASIVE PROCEDURES:  He had an EP study
and a DDD pacemaker placement.

DISCHARGE CONDITION:  Stable.

DISCHARGE MEDICATIONS:
1. [**Doctor First Name **] 60 mg capsule po q day.
2. Atorvastatin 20 mg po q day.
3. Terazosin one 2 mg tablet po q hs.
4. Allopurinol 100 mg po q day.
5. Aspirin 325 mg po q day.
6. Terbinafine 1% cream applied topically [**Hospital1 **] as needed for
rash x5 days.
7. Lisinopril 20 mg po q day.
8. Percocet one tablet po q4-6 as needed for pain.
9. Keflex 250 mg capsule po qid x3 days.

CONDITION ON DISCHARGE:  Stable.



                          [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(2) 2139**]

Dictated By:[**Name8 (MD) 8736**]

MEDQUIST36

D:  [**2161-9-24**]  21:34
T:  [**2161-9-27**]  11:17
JOB#:  [**Job Number 106188**]

cc:[**Last Name (NamePattern1) **]
{'Other second degree atrioventricular block,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dermatophytosis of the body,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Old myocardial infarction'}


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: 

PRESENT ILLNESS: This is a 75-year-old male with
past medical history of coronary artery disease status post
three vessel CABG in [**2156**].  He had a LIMA to the LAD,
saphenous vein graft to the PDA, and saphenous vein graft to
OM-1.  This was stented four years ago, congestive heart
failure with an ejection fraction of 25%, chronic renal
insufficiency, and left bundle branch block, who presented to
the Emergency Room after an episode of bradycardia with his
heart rate in the 30s, and was found to have 2:1 heart block.

MEDICAL HISTORY: 1. Coronary artery disease status post myocardial infarction
and coronary artery bypass graft in [**2156**].
2. Congestive heart failure with an ejection fraction of
20-25%.
3. Gout.
4. Hypertension, normal runs 116/60.
5. Prostate cancer status post XRT and hormone therapy.
6. Obese.
7. Ocular melanoma in his left eye status post proton-beam
therapy.
8. Chronic renal insufficiency.
9. Cholecystectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: He has an allergy to contrast dye years ago when
he had his cholecystectomy.  Since then, he has received
contrast and had no adverse reactions.

PHYSICAL EXAM: 

FAMILY HISTORY: His father died at 68 of "cardiac causes."

SOCIAL HISTORY: He is married with two children.  He has
social alcohol use in his teen years.  No recent alcohol use,
no tobacco smoking. 

### Response:
{'Other second degree atrioventricular block,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dermatophytosis of the body,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Old myocardial infarction'}
