CHIEF COMPLAINT: syncope

PRESENT ILLNESS: 69 yo man with h/o of hypercholesterolemia and renal ca > 20
years PTA who
p/w syncope on AM off admission.  Pt was in USOH until AM on DOA
when he awoke gasping for air. He got up out of bed, became
dizzy and fell into the nightstand next to his bed, hitting his
face in the process and lacerating his nose and lip.  The fall
was unwitnessed.  He came to, his wife called the EMS and the pt
was BIBA to the ER. On the way to the hospital, the EMTs noted
his HR to be in the 40s with CHB, then he dropped his HR into
the 20s and had two 10-second seizures. He received 1mg atropine
and 350cc NS with good effect, his HR and BP increasing. In the
ED he remained stable in CHB, a Cordis sheath was inserted, and
he came to the CCU with external pacing pads on and ready if
needed.

MEDICAL HISTORY: Hypercholesterolemia
Renal cell CA s/p nephrectomy 20y PTA

MEDICATION ON ADMISSION: ASA 325mg po qd
Lipitor 20mg po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: HR 48,  BP 120/66,  RR 20,  O2 sat 99% on 2LNC, afebrile
Gen: older man, lying on stretcher, NAD
HEENT: R IJ line in neck; lacerations on nose and upper lip;
MMM; OP clear
CV: irreg irreg rhythm; nl s1s2 no m/g/r; no carotid bruits
Lungs: CTA b/l, no w/r/r
Abd: soft, NT, ND, +BS
Ext: no LE edema, FROM x 4, 2+ DP pulses
Neuro/Psych: nonfocal; approp affect, linear TP

FAMILY HISTORY: noncontributory; no CAD

SOCIAL HISTORY: Insurance lawyer; married, lives with his wife in [**Name (NI) 86**]; h/o
smoking in the past though he quit; social etoh, 1-2 drinks, 2
times per week; no other drug use; walks regularly
Atrioventricular block, complete,Syncope and collapse,Accidental fall from bed,Open wound of lip, without mention of complication,Other specified diseases due to viruses,Personal history of tobacco use,Fitting and adjustment of cardiac pacemaker
Atriovent block complete,Syncope and collapse,Fall from bed,Open wound of lip,Oth spec dis viruses,History of tobacco use,Ftng cardiac pacemaker
Admission Date:  [**2177-8-30**]              Discharge Date:   [**2177-9-2**]

Date of Birth:  [**2108-7-31**]             Sex:   M

Service: [**Hospital Unit Name 196**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9554**]
Chief Complaint:
syncope

Major Surgical or Invasive Procedure:
PPM implantation

History of Present Illness:
69 yo man with h/o of hypercholesterolemia and renal ca > 20
years PTA who
p/w syncope on AM off admission.  Pt was in USOH until AM on DOA
when he awoke gasping for air. He got up out of bed, became
dizzy and fell into the nightstand next to his bed, hitting his
face in the process and lacerating his nose and lip.  The fall
was unwitnessed.  He came to, his wife called the EMS and the pt
was BIBA to the ER. On the way to the hospital, the EMTs noted
his HR to be in the 40s with CHB, then he dropped his HR into
the 20s and had two 10-second seizures. He received 1mg atropine
and 350cc NS with good effect, his HR and BP increasing. In the
ED he remained stable in CHB, a Cordis sheath was inserted, and
he came to the CCU with external pacing pads on and ready if
needed.

Past Medical History:
Hypercholesterolemia
Renal cell CA s/p nephrectomy 20y PTA

Social History:
Insurance lawyer; married, lives with his wife in [**Name (NI) 86**]; h/o
smoking in the past though he quit; social etoh, 1-2 drinks, 2
times per week; no other drug use; walks regularly

Family History:
noncontributory; no CAD

Physical Exam:
Vitals: HR 48,  BP 120/66,  RR 20,  O2 sat 99% on 2LNC, afebrile
Gen: older man, lying on stretcher, NAD
HEENT: R IJ line in neck; lacerations on nose and upper lip;
MMM; OP clear
CV: irreg irreg rhythm; nl s1s2 no m/g/r; no carotid bruits
Lungs: CTA b/l, no w/r/r
Abd: soft, NT, ND, +BS
Ext: no LE edema, FROM x 4, 2+ DP pulses
Neuro/Psych: nonfocal; approp affect, linear TP

Pertinent Results:
[**2177-8-30**] 05:10AM BLOOD WBC-13.3* RBC-4.39* Hgb-14.0 Hct-42.2
MCV-96 MCH-31.9 MCHC-33.2 RDW-13.5 Plt Ct-305
[**2177-9-2**] 05:40AM BLOOD WBC-14.5* RBC-4.21* Hgb-13.9* Hct-39.4*
MCV-94 MCH-33.1* MCHC-35.4* RDW-13.1 Plt Ct-263
[**2177-8-30**] 05:10AM BLOOD Neuts-20* Bands-0 Lymphs-70* Monos-4
Eos-2 Baso-0 Atyps-4* Metas-0 Myelos-0
[**2177-8-30**] 05:10AM BLOOD Plt Smr-NORMAL Plt Ct-305
[**2177-8-31**] 06:20AM BLOOD PT-13.0 PTT-25.4 INR(PT)-1.1
[**2177-9-2**] 05:40AM BLOOD Plt Ct-263
[**2177-8-30**] 02:40PM BLOOD ESR-4
[**2177-8-30**] 10:55AM BLOOD Parst S-NEG
[**2177-8-30**] 05:10AM BLOOD Glucose-241* UreaN-31* Creat-1.4* Na-143
K-3.5 Cl-107 HCO3-22 AnGap-18
[**2177-9-2**] 05:40AM BLOOD Glucose-82 UreaN-20 Creat-1.0 Na-140
K-4.0 Cl-102 HCO3-25 AnGap-17
[**2177-8-30**] 05:10AM BLOOD CK(CPK)-86
[**2177-8-30**] 02:40PM BLOOD ALT-47* AST-22 AlkPhos-47 TotBili-1.2
[**2177-8-31**] 06:20AM BLOOD CK(CPK)-109
[**2177-8-30**] 05:10AM BLOOD cTropnT-<0.01
[**2177-8-31**] 06:20AM BLOOD CK-MB-2
[**2177-8-31**] 06:20AM BLOOD Calcium-9.0 Phos-3.1 Mg-2.0
[**2177-9-2**] 05:40AM BLOOD TotProt-6.1* Calcium-9.2 Phos-4.1 Mg-1.9
[**2177-8-30**] 05:10AM BLOOD TSH-5.0*
[**2177-8-30**] 02:40PM BLOOD T4-6.0
[**2177-9-2**] 05:40AM BLOOD PEP-ABNORMAL B IgG-730 IgA-50* IgM-14*
IFE-MONOCLONAL

Brief Hospital Course:
In the CCU:

1. CHB/Rhythm
Pt arrived in CCU in NSR in 70s. Etiology of CHB thought to be
fibrous change c/w pt's known prior conduction disease. Lyme,
Ehrlichiosis and Babesiosis serologies were sent which were
ultimately negative. Monospot negative. Pt received PPM without
complications. PPM was [**Company 1543**] EnPulse DDDR. Pt was
transferred to floor after receiving his PPM then d/c'd on his
2nd post-procedure day.

2. Elevated WBC
Pt noted to have WBC of 13.3 without fever but with malaise for
2 months; pt's family reported that his WBC has been elevated
"all summer" with no workup performed to date. Smudge cells were
seen on pt's smear, common in malignancy (CLL?), though ESR was
low at 4. Heme/Onc consulted to evaluate, recommended flow
cytometry to r/o CLL and want to see pt in one month for further
eval as outpatient. Pt given the contact info and instructed to
set up the appointment.

3. Renal
Pt has h/o Renal Cell CA s/p nephrectomy, Cr 1.4 on admission.
No issues on this admission.

4. Derm
Skin lacerations from fall; Plastics consulted to evaluate, they
sutured the wounds and prescribed antibiotic cream. They removed
the sutures prioor to pt's discharge.

Medications on Admission:
ASA 325mg po qd
Lipitor 20mg po qd

Discharge Medications:
1. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
Disp:*30 Tablet(s)* Refills:*2*
3. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 4 days.
Disp:*16 Capsule(s)* Refills:*0*
4. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. Percocet 5-325 mg Tablet Sig: One (1) Tablet PO every [**4-8**]
hours as needed for pain for 4 days.
Disp:*16 Tablet(s)* Refills:*0*
6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day for
4 days: To keep stool soft while taking Percocet.
Disp:*8 Capsule(s)* Refills:*0*
7. Ativan 1 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia for 4 days: Please take only as needed for
sleep; do not take prior to activity or operating heavy
machinery.
Disp:*4 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Complete Heart Block


Discharge Condition:
left pocket wound, no hematoma

Discharge Instructions:
Please contact the Hematology Division in one week to set up a
follow up appointment.

Please keep your skin incision site clean and dry.

Followup Instructions:
Please call the Hematology Division in one week to set up an
appointment.

Device Clinic [**Hospital Ward Name 23**] 7 [**2177-9-9**] 9:30am Device Clinic [**First Name8 (NamePattern2) 1439**]
[**Last Name (NamePattern1) 4949**], [**First Name8 (NamePattern2) 11320**] [**Last Name (NamePattern1) **]
Provider:  [**Name10 (NameIs) 676**] CLINIC Where: [**Hospital6 29**] CARDIAC
SERVICES Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2178-2-11**] 2:00
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 677**], M.D. Where: [**Hospital6 29**]
CARDIAC SERVICES Phone:[**Telephone/Fax (1) 2934**] Date/Time:[**2178-2-11**] 2:30


                             [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2139**]
{'Atrioventricular block, complete,Syncope and collapse,Accidental fall from bed,Open wound of lip, without mention of complication,Other specified diseases due to viruses,Personal history of tobacco use,Fitting and adjustment of cardiac pacemaker'}


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: syncope

PRESENT ILLNESS: 69 yo man with h/o of hypercholesterolemia and renal ca > 20
years PTA who
p/w syncope on AM off admission.  Pt was in USOH until AM on DOA
when he awoke gasping for air. He got up out of bed, became
dizzy and fell into the nightstand next to his bed, hitting his
face in the process and lacerating his nose and lip.  The fall
was unwitnessed.  He came to, his wife called the EMS and the pt
was BIBA to the ER. On the way to the hospital, the EMTs noted
his HR to be in the 40s with CHB, then he dropped his HR into
the 20s and had two 10-second seizures. He received 1mg atropine
and 350cc NS with good effect, his HR and BP increasing. In the
ED he remained stable in CHB, a Cordis sheath was inserted, and
he came to the CCU with external pacing pads on and ready if
needed.

MEDICAL HISTORY: Hypercholesterolemia
Renal cell CA s/p nephrectomy 20y PTA

MEDICATION ON ADMISSION: ASA 325mg po qd
Lipitor 20mg po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: HR 48,  BP 120/66,  RR 20,  O2 sat 99% on 2LNC, afebrile
Gen: older man, lying on stretcher, NAD
HEENT: R IJ line in neck; lacerations on nose and upper lip;
MMM; OP clear
CV: irreg irreg rhythm; nl s1s2 no m/g/r; no carotid bruits
Lungs: CTA b/l, no w/r/r
Abd: soft, NT, ND, +BS
Ext: no LE edema, FROM x 4, 2+ DP pulses
Neuro/Psych: nonfocal; approp affect, linear TP

FAMILY HISTORY: noncontributory; no CAD

SOCIAL HISTORY: Insurance lawyer; married, lives with his wife in [**Name (NI) 86**]; h/o
smoking in the past though he quit; social etoh, 1-2 drinks, 2
times per week; no other drug use; walks regularly 

### Response:
{'Atrioventricular block, complete,Syncope and collapse,Accidental fall from bed,Open wound of lip, without mention of complication,Other specified diseases due to viruses,Personal history of tobacco use,Fitting and adjustment of cardiac pacemaker'}
