CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 81-year-old
woman with a history of dilated ischemic cardiomyopathy who
had been in her usual good state of health.  She went to a
wedding on [**Hospital3 **].  Following this she had dizziness while
sitting down.  She had no pain.  She took a sublingual
nitroglycerin tablet and felt worse, diaphoretic, and went to
[**Hospital **] [**Hospital **] Hospital via Emergency Medical Service.  She was
asymptomatic by arrival to their Emergency Room.  She
experienced no pain during any of this.  While at [**Hospital3 **]
Hospital on telemetry she had a run of wide complex
tachycardia associated with hypotension to a systolic blood
pressure of 80s.  She was started on intravenous amiodarone
and planned for transfer to [**Hospital1 188**].  She did not have recurrence of the tachycardia after
the amiodarone was started.  She did, however, have
bradycardia to a heart rate in the 40s and hypotension again
to a systolic blood pressure in the 80s.  Amiodarone
intravenously was given at 1 mg per minute from 1430 to 2230
on [**2164-8-26**].  Amiodarone at 0.5 mg per minute was
given from 2230 until arrival at [**Hospital1 190**] at midnight when the bottle broke on transfer.
She has had some increased of shortness of breath with
exertion over the past two months as well as a cold which has
totally resolved.  She denied headache, chest pain,
orthopnea, paroxysmal nocturnal dyspnea, pedal edema,
abdominal pain, nausea, vomiting, dysuria or back pain.  She
gets short of breath at one flight of stairs but is able to
work out for 10 minutes on a stationary bike.

MEDICAL HISTORY: (Previous medical history is
significant for)
1.  Coronary artery disease, status post myocardial
infarction in [**2159**], complicated by cardiogenic shock.
2.  Status post cardiac catheterization in [**2159**] with a normal
right coronary artery, 70% proximal left anterior descending
artery, 100% middle left anterior descending artery, a normal
left circumflex, and diffuse second obtuse marginal.
3.  Cardiac stress test in [**2162-8-27**] with large fixed
abnormalities involving anterior wall, lateral wall near the
cardiac apex and sputum, mild reversible abnormality of the
inferior wall, marked ventricular chamber dilatation with
global diffuse hypokinesis and decreased ejection fraction
of 13%.
4.  Hypothyroidism.
5.  Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy.
6.  Peptic ulcer disease with a history of bleeding; last
bleeding was greater than 30 years ago.
7.  Paroxysmal atrial fibrillation; echocardiogram on
[**2164-7-17**], revealed left ventricular ejection fraction
of 10%, depressed right ventricular ejection fraction, 1+
mitral regurgitation, trace aortic insufficiency, entire
intraventricular septum and anterior wall were thin, fibrotic
and akinetic, apex was frankly dyskinetic; all other segments
of the left ventricle were severely hypokinetic and extensive
spontaneous echocontrast throughout the left ventricular
cavity consistent with an old mural thrombus.
8.  Glaucoma.
9.  Hepatitis (unclear type).

MEDICATION ON ADMISSION: Her medications at home include
Lopressor 12.5 mg p.o. b.i.d., aspirin 81 mg p.o. q.d.,
Zantac 150 mg p.o. b.i.d., Lipitor 10 mg p.o. q.d.,
digoxin 0.125 mg p.o. q.d. (held on admission), Coumadin 3 mg
p.o. q.d. (held on admission), amiodarone 200 mg p.o. on
Monday, Wednesday and Friday (was admitted on intravenous
amiodarone at 0.5 mg per minute), Synthroid 75 mcg p.o. q.d.,
Lasix 40 mg p.o. q.d., Zestril 20 mg p.o. q.d., Timoptic 0.5%
OU q.h.s., Lovenox 50 mg p.o. q.12h.

ALLERGIES: There were no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is widowed.  Formerly worked
managing a law firm, but retired at age 55.  Lives in
apartment at [**Hospital1 **] Community Center in [**Location (un) 745**].  Works out on
machines, 10 minutes on a stationary bike.  Smoked an unclear
amount from 17 until 52.  Never a serious drinker.
Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Other specified conduction disorders,Anemia, unspecified,Other opiates and related narcotics causing adverse effects in therapeutic use,Abnormal coagulation profile,Other specified forms of chronic ischemic heart disease
Parox ventric tachycard,CHF NOS,Conduction disorder NEC,Anemia NOS,Adv eff opiates,Abnrml coagultion prfile,Chr ischemic hrt dis NEC
Name:  [**Known lastname 15918**], [**Known firstname 9854**] L                       Unit No:  [**Numeric Identifier 15919**]

Admission Date:  [**2164-8-27**]     Discharge Date:  [**2164-9-11**]

Date of Birth:   [**2082-11-2**]     Sex:  F

Service:  Cardiology

ADDENDUM:
HOSPITAL COURSE:  The patient underwent an electrophysiology
study and ventricular tachycardia focus ablation on [**2164-8-29**].
Eight different inducible foci were ablated.  The patient
tolerated the procedure well.  There were some residual
ventricular tachycardic foci remaining and the patient was
placed on Amiodarone 400 mg per day times three months and it
was planned to have a biventricular automatic implantable
converter and defibrillator placed on the following Monday.
The patient remained on the inpatient service with no
complications from her ablation, no ectopic beats on
monitoring by telemetry.  On [**2164-9-3**] the patient underwent
AICD placement.  The procedure was complicated by difficult
placement of the wires with multiple attempts of placement of
the leads.  The patient became hypotensive during the
procedure.  An echocardiogram demonstrated that there was no
pericardial effusion or tamponade.  The patient was placed on
Dopamine with good recovery of blood pressure and it was
presumed that her hypotension was secondary to high dose of
Fentanyl given during the procedure.  The patient was
transferred to the Intensive Care Unit on Dopamine drip for
maintenance of blood pressure.  The patient was found the
following morning to be in an accelerated idioventricular
rhythm with AV dissociation and that this was contributing to
her hypotension with systolic blood pressures only 70-80 on
13 mcg of Dopamine.  EP service was called and A pace
terminated the AVR with burst pacing and pressures
immediately increased to 110-120 systolic.  Dopamine was then
slowly weaned off over the next several days and the patient
was transferred out of the Intensive Care Unit on [**2164-9-7**].
During this time the patient's hematocrit dropped from 30
down to 25.9.  She was transfused with one unit of blood and
her hematocrit increased to 31.6.  The patient remained in
stable condition until the night of [**2164-9-9**] when at 12:30 in
the morning house staff was called to see Mrs. [**Known lastname **] for
assistance and management of acute respiratory distress.  She
was found to have heart rates 100 to 110, systolic blood
pressures 160's, respiratory rate in the 40's, SAO2 85% on
100% non rebreather with jugular venous pulses increased in
the neck to 10 cm and crackles and rhonchi throughout with
retracting and paradoxical breathing.  EKG at that time
showed AV dissociation, atrial rate of about 80, ventricular
rate of about 100, wide left bundle branch block type with a
left axis.  The patient was given Lasix 60 mg, Morphine
Sulfate 2 mg IV, IV Nitroglycerin drip was started.  She was
given another 2 mg of Morphine Sulfate and 120 mg of Lasix
IV.  With this, her SAO2 increased to 95% on 100% non
rebreather and respiratory rate decreased now to 20 with only
retracting during breathing and no paradoxical.  The patient
was transferred to an ICU setting for non invasive
monitoring.  She was continued with preload reduction with
Nitrates and Morphine and diuresis.  We discussed the use of
mechanical ventilation intervention with her and she does not
want this as previously discussed during this admission with
Dr. [**Last Name (STitle) 1426**], even if likely temporary under any circumstances.
Electrophysiology service was called at 2:30 a.m. on [**9-9**]
and they were able to burst pace her AICD which showed
immediate response in blood pressure to SVTs of 100 and it
was decided to continue Amiodarone.  No further Lasix was
given.  The patient continued to put out good urine.  Later
the following morning the patient was seen by the EP service
fellow again.  He attempted to program the ICD to detect 90
beats per minute, however, the algorithm would not permit
rate less than 100 beats per minute.  He changed VT detection
to 100 beats per minute, programmed 19 algorithms followed by
a 10 joule cardioversion.  He decreased V fib detection from
320 milliseconds to 340 milliseconds, activated all SVT
detection algorithms.  PA and lateral chest x-ray was
performed during the day showing no pneumonia, no effusion
and some resolution of congestive heart failure.
Electrolytes were checked and abnormalities were corrected
and it was planned that if an AIVR, slow V tach returned,
that Lidocaine would be used intravenously to assess class IB
anti-arrhythmic efficiency.  This may provide support to
combine Amiodarone and Mexiletine in future if efficacious.
Following these adjustments and the biventricular pacer, the
patient remained stable, continued to diurese well with no
further episodes of AIVR or VT.  During this time afterload
reduction was introduced with Captopril 6.25 mg tid.  This
was changed on [**2164-9-10**] to Zestril 5 mg per day and preload
reduction was added with Lasix 40 mg per day.  It was felt
that preload and afterload reduction would help prevent the
patient from decompensating into congestive heart failure so
rapidly should the AIVR slow VT return.  It was decided not
to add any other anti-arrhythmics at this time and the
ability of the AICD to defibrillate V tach, V fib would not
be tested during this admission.  The patient continued to do
well, her respiratory status improved so that she was
saturating 98% on room air.  She was cleared by physical
therapy for discharge to home and she will follow-up in two
weeks with Dr. [**Last Name (STitle) 1426**] of cardiology and with the
electrophysiology service device clinic.  Appointment times
remain to be determined.

DISCHARGE MEDICATIONS:  Lasix 40 mg per day, Zestril 5 mg per
day, Protonix 40 mg per day, Amiodarone 400 mg per day times
three months and then 200 mg per day, Lipitor 10 mg per day,
Timoptic 0.5% one drop each eye per day, Colace 100 mg po
bid, Aspirin 81 mg per day.  It was elected not to start
anticoagulation or beta blockade at this time and this will
be followed up on her visit with Dr. [**Last Name (STitle) 1426**] in two weeks.

DISCHARGE STATUS:  DNR, DNI.

DISCHARGE DIAGNOSIS:
1.  Ventricular arrhythmia.

CONDITION ON DISCHARGE:  Good.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1729**], M.D.  [**MD Number(1) 6268**]

Dictated By:[**Name8 (MD) 502**]

MEDQUIST36

D:  [**2164-9-10**]  15:25
T:  [**2164-9-13**]  11:20
JOB#:  [**Job Number **]


Admission Date:  [**2164-8-27**]     Discharge Date:  [**2164-9-11**]


Service:  Cardiology

HISTORY OF PRESENT ILLNESS:  The patient is an 81-year-old
woman with a history of dilated ischemic cardiomyopathy who
had been in her usual good state of health.  She went to a
wedding on [**Hospital3 **].  Following this she had dizziness while
sitting down.  She had no pain.  She took a sublingual
nitroglycerin tablet and felt worse, diaphoretic, and went to
[**Hospital **] [**Hospital **] Hospital via Emergency Medical Service.  She was
asymptomatic by arrival to their Emergency Room.  She
experienced no pain during any of this.  While at [**Hospital3 **]
Hospital on telemetry she had a run of wide complex
tachycardia associated with hypotension to a systolic blood
pressure of 80s.  She was started on intravenous amiodarone
and planned for transfer to [**Hospital1 188**].  She did not have recurrence of the tachycardia after
the amiodarone was started.  She did, however, have
bradycardia to a heart rate in the 40s and hypotension again
to a systolic blood pressure in the 80s.  Amiodarone
intravenously was given at 1 mg per minute from 1430 to 2230
on [**2164-8-26**].  Amiodarone at 0.5 mg per minute was
given from 2230 until arrival at [**Hospital1 190**] at midnight when the bottle broke on transfer.
She has had some increased of shortness of breath with
exertion over the past two months as well as a cold which has
totally resolved.  She denied headache, chest pain,
orthopnea, paroxysmal nocturnal dyspnea, pedal edema,
abdominal pain, nausea, vomiting, dysuria or back pain.  She
gets short of breath at one flight of stairs but is able to
work out for 10 minutes on a stationary bike.

PAST MEDICAL HISTORY:  (Previous medical history is
significant for)
1.  Coronary artery disease, status post myocardial
infarction in [**2159**], complicated by cardiogenic shock.
2.  Status post cardiac catheterization in [**2159**] with a normal
right coronary artery, 70% proximal left anterior descending
artery, 100% middle left anterior descending artery, a normal
left circumflex, and diffuse second obtuse marginal.
3.  Cardiac stress test in [**2162-8-27**] with large fixed
abnormalities involving anterior wall, lateral wall near the
cardiac apex and sputum, mild reversible abnormality of the
inferior wall, marked ventricular chamber dilatation with
global diffuse hypokinesis and decreased ejection fraction
of 13%.
4.  Hypothyroidism.
5.  Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy.
6.  Peptic ulcer disease with a history of bleeding; last
bleeding was greater than 30 years ago.
7.  Paroxysmal atrial fibrillation; echocardiogram on
[**2164-7-17**], revealed left ventricular ejection fraction
of 10%, depressed right ventricular ejection fraction, 1+
mitral regurgitation, trace aortic insufficiency, entire
intraventricular septum and anterior wall were thin, fibrotic
and akinetic, apex was frankly dyskinetic; all other segments
of the left ventricle were severely hypokinetic and extensive
spontaneous echocontrast throughout the left ventricular
cavity consistent with an old mural thrombus.
8.  Glaucoma.
9.  Hepatitis (unclear type).

MEDICATIONS ON ADMISSION:  Her medications at home include
Lopressor 12.5 mg p.o. b.i.d., aspirin 81 mg p.o. q.d.,
Zantac 150 mg p.o. b.i.d., Lipitor 10 mg p.o. q.d.,
digoxin 0.125 mg p.o. q.d. (held on admission), Coumadin 3 mg
p.o. q.d. (held on admission), amiodarone 200 mg p.o. on
Monday, Wednesday and Friday (was admitted on intravenous
amiodarone at 0.5 mg per minute), Synthroid 75 mcg p.o. q.d.,
Lasix 40 mg p.o. q.d., Zestril 20 mg p.o. q.d., Timoptic 0.5%
OU q.h.s., Lovenox 50 mg p.o. q.12h.

ALLERGIES:  There were no known drug allergies.

SOCIAL HISTORY:  The patient is widowed.  Formerly worked
managing a law firm, but retired at age 55.  Lives in
apartment at [**Hospital1 **] Community Center in [**Location (un) 745**].  Works out on
machines, 10 minutes on a stationary bike.  Smoked an unclear
amount from 17 until 52.  Never a serious drinker.

PHYSICAL EXAMINATION ON ADMISSION:  On examination, the
patient was comfortable, wearing lipstick, talking on the
phone.  Temperature 98, heart rate 54, blood pressure 103/49,
respiratory rate 19, saturating 96% on 2 liters.  Her eyes
were anicteric.  Extraocular muscles were intact.  Moist
mucous membranes without lesions.  Neck was supple.  Jugular
venous distention was observed at 6 cm.  On heart
examination, there was a dyskinetic point of maximal impulse
laterally displaced.  Rate was regular, soft S4, soft
holosystolic murmur at the apex.  Examination of the lungs
revealed crackles one-quarter of the way up.  The abdomen was
soft, nontender, and nondistended, normal active bowel
sounds.  No organomegaly by examination.  Extremities
revealed no edema, and 2+ dorsalis pedis pulses.

LABORATORY DATA ON ADMISSION:   Laboratories on admission
were significant for a hematocrit of 34.1, with a MCV of 88.
An albumin of 3.6.  Chemistry of 9.  An INR of 3.4, and
digoxin level of 1.3.

RADIOLOGY/IMAGING:   Her electrocardiogram showed somewhat
broad complex tachycardia at 130 msec, QRS of right
bundle-branch block type, RS complex was absent in all
precordial leads with Q waves across the precordium.  Also in
lead II probable AD disassociation.

Her electrocardiogram on arrival at [**Hospital1 190**] showed normal sinus rhythm with a long P-R,
slightly broad QRS, poor R wave progression, and a left axis.

HOSPITAL COURSE:   The patient was admitted with probable
ventricular tachycardia or accelerated idioventricular rhythm
and was referred to the Electrophysiology Service for
evaluation.

An addendum to this dictation is to follow.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D.  [**MD Number(1) 1014**]

Dictated By:[**Name8 (MD) 4430**]

MEDQUIST36

D:  [**2164-9-11**]  13:45
T:  [**2164-9-11**]  19:36
JOB#:  [**Job Number **]

 (cclist)
{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Other specified conduction disorders,Anemia, unspecified,Other opiates and related narcotics causing adverse effects in therapeutic use,Abnormal coagulation profile,Other specified forms of chronic ischemic heart disease'}


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: The patient is an 81-year-old
woman with a history of dilated ischemic cardiomyopathy who
had been in her usual good state of health.  She went to a
wedding on [**Hospital3 **].  Following this she had dizziness while
sitting down.  She had no pain.  She took a sublingual
nitroglycerin tablet and felt worse, diaphoretic, and went to
[**Hospital **] [**Hospital **] Hospital via Emergency Medical Service.  She was
asymptomatic by arrival to their Emergency Room.  She
experienced no pain during any of this.  While at [**Hospital3 **]
Hospital on telemetry she had a run of wide complex
tachycardia associated with hypotension to a systolic blood
pressure of 80s.  She was started on intravenous amiodarone
and planned for transfer to [**Hospital1 188**].  She did not have recurrence of the tachycardia after
the amiodarone was started.  She did, however, have
bradycardia to a heart rate in the 40s and hypotension again
to a systolic blood pressure in the 80s.  Amiodarone
intravenously was given at 1 mg per minute from 1430 to 2230
on [**2164-8-26**].  Amiodarone at 0.5 mg per minute was
given from 2230 until arrival at [**Hospital1 190**] at midnight when the bottle broke on transfer.
She has had some increased of shortness of breath with
exertion over the past two months as well as a cold which has
totally resolved.  She denied headache, chest pain,
orthopnea, paroxysmal nocturnal dyspnea, pedal edema,
abdominal pain, nausea, vomiting, dysuria or back pain.  She
gets short of breath at one flight of stairs but is able to
work out for 10 minutes on a stationary bike.

MEDICAL HISTORY: (Previous medical history is
significant for)
1.  Coronary artery disease, status post myocardial
infarction in [**2159**], complicated by cardiogenic shock.
2.  Status post cardiac catheterization in [**2159**] with a normal
right coronary artery, 70% proximal left anterior descending
artery, 100% middle left anterior descending artery, a normal
left circumflex, and diffuse second obtuse marginal.
3.  Cardiac stress test in [**2162-8-27**] with large fixed
abnormalities involving anterior wall, lateral wall near the
cardiac apex and sputum, mild reversible abnormality of the
inferior wall, marked ventricular chamber dilatation with
global diffuse hypokinesis and decreased ejection fraction
of 13%.
4.  Hypothyroidism.
5.  Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy.
6.  Peptic ulcer disease with a history of bleeding; last
bleeding was greater than 30 years ago.
7.  Paroxysmal atrial fibrillation; echocardiogram on
[**2164-7-17**], revealed left ventricular ejection fraction
of 10%, depressed right ventricular ejection fraction, 1+
mitral regurgitation, trace aortic insufficiency, entire
intraventricular septum and anterior wall were thin, fibrotic
and akinetic, apex was frankly dyskinetic; all other segments
of the left ventricle were severely hypokinetic and extensive
spontaneous echocontrast throughout the left ventricular
cavity consistent with an old mural thrombus.
8.  Glaucoma.
9.  Hepatitis (unclear type).

MEDICATION ON ADMISSION: Her medications at home include
Lopressor 12.5 mg p.o. b.i.d., aspirin 81 mg p.o. q.d.,
Zantac 150 mg p.o. b.i.d., Lipitor 10 mg p.o. q.d.,
digoxin 0.125 mg p.o. q.d. (held on admission), Coumadin 3 mg
p.o. q.d. (held on admission), amiodarone 200 mg p.o. on
Monday, Wednesday and Friday (was admitted on intravenous
amiodarone at 0.5 mg per minute), Synthroid 75 mcg p.o. q.d.,
Lasix 40 mg p.o. q.d., Zestril 20 mg p.o. q.d., Timoptic 0.5%
OU q.h.s., Lovenox 50 mg p.o. q.12h.

ALLERGIES: There were no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is widowed.  Formerly worked
managing a law firm, but retired at age 55.  Lives in
apartment at [**Hospital1 **] Community Center in [**Location (un) 745**].  Works out on
machines, 10 minutes on a stationary bike.  Smoked an unclear
amount from 17 until 52.  Never a serious drinker. 

### Response:
{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Other specified conduction disorders,Anemia, unspecified,Other opiates and related narcotics causing adverse effects in therapeutic use,Abnormal coagulation profile,Other specified forms of chronic ischemic heart disease'}
