CHIEF COMPLAINT: VT arrest

PRESENT ILLNESS: 62 yo male w/ PMHx significant for HTN, hypercholesterolemia,
DM, CRI, and prior V-fib arrest, presented to the ER w/ sob and
cough.  He has been well until yesterday evening when he had a
cough.  Overnight the patient had an episode on non-bloody
emesis.  Today the patient experienced sob and chills and was
[**Last Name (un) 4662**] to the [**Hospital1 18**] ER.

MEDICAL HISTORY: HTN
Diabetes
Vfib arrest [**2-16**]

MEDICATION ON ADMISSION: 

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: Vitals admission - Temp 100.1  BP 159/70  P 85  RR 48  O2 sat
68% RA

FAMILY HISTORY: The patient's mother had [**Name (NI) 2481**].  No other known family
history.  He is a former smoker, quit 30 years ago.  Occasional
alcohol.  He is a retired tailor.  He is married with several
children.

SOCIAL HISTORY: 
Acute respiratory failure,Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Anoxic brain damage,Acute kidney failure, unspecified,Influenza with pneumonia,Unspecified septicemia,Severe sepsis,Septic shock,Grand mal status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia
Acute respiratry failure,Parox ventric tachycard,CHF NOS,Anoxic brain damage,Acute kidney failure NOS,Influenza with pneumonia,Septicemia NOS,Severe sepsis,Septic shock,Grand mal status,Hyp kid NOS w cr kid V,DMII wo cmp nt st uncntr,Pure hypercholesterolem
Admission Date:  [**2108-1-7**]              Discharge Date:   [**2108-1-25**]

Date of Birth:  [**2045-4-14**]             Sex:   M

Service: MEDICINE

Allergies:
Iodine; Iodine Containing

Attending:[**Doctor First Name 1402**]
Chief Complaint:
VT arrest

Major Surgical or Invasive Procedure:
intubation


History of Present Illness:
62 yo male w/ PMHx significant for HTN, hypercholesterolemia,
DM, CRI, and prior V-fib arrest, presented to the ER w/ sob and
cough.  He has been well until yesterday evening when he had a
cough.  Overnight the patient had an episode on non-bloody
emesis.  Today the patient experienced sob and chills and was
[**Last Name (un) 4662**] to the [**Hospital1 18**] ER.

In triage, the patient had an O2 sat of 68% and a RR of 48.  He
was brought to an ER room and became unresponsive.  He was
bradycardic to the 20's without a pulse.  He was given
epinephrine and chest compressions were started.  The patient
went into a junctional rhythm without a pulse and was given
atropine and intubated shortly thereafter.  A pulse was briefly
regained and then the patient went pulseless again, went into
VT.  Pt was shocked at 200 joules and the pulse was regained.
Amiodarone 300 mg IV push was given.  The patient then entered
sinus rhythm after ~ 5 minutes.

The following day, the patient became febrile to 102.5 and was
pan cultured. Simultaneously, he became less responsive and
rigid, without gag or corneal reflex and sluggish pupils
bilaterally.

Past Medical History:
HTN
Diabetes
Vfib arrest [**2-16**]

Family History:
The patient's mother had [**Name (NI) 2481**].  No other known family
history.  He is a former smoker, quit 30 years ago.  Occasional
alcohol.  He is a retired tailor.  He is married with several
children.


Physical Exam:
Vitals admission - Temp 100.1  BP 159/70  P 85  RR 48  O2 sat
68% RA

Gen: intubated
HEENT:
CV: bradycardic S1/S2 no m/r/g
Resp: coarse BS anteriorly b/l
Abd: soft NT ND + BS
Ext: no c/c/e
Neuro: moving all four extremities

Pertinent Results:
EKG post arrest - NSR, LBBB, PR 220

[**3-8**] echocardiography - EF 35-40%, RA moderately dilated, small
ASD, mild LVH, depressed LV systolic function.
Septal/inferolateral/inferior hypokinesis.  Aortic root
moderately dilated.  Ascending aorta moderately dilated.  Mild
AR, mild MR, moderate pulmonary artery systolic hypertension.

[**2106-2-25**] cardiac cathterization - RCA dominant vessel.  PCWP 25
LVEDP 24  CI 2.7  EF 56%  LAD 30% leison, D3 80% stenosis, large
intermedius branch 40% ostial lesion, LCx 40% proximal 70%
distal after OM1.  OM1 50% tubular stenotic lesion.

CXR - b/l pulmonary edema

Brief Hospital Course:
62 yo male w/ PMHx significant for HTN, hypercholesterolemia,
DM, CRI, and prior V-fib arrest
.
CV - cardiac arrest likely precipitated hypoxia/acidosis.  Pt
has a wide QRS at baseline, some of wide complex tachycardia may
not be VT.
.
CAD - His ASA/Statin/ were continued but BB was held since
patient was bradycardic on amiodarone
.
[**Name (NI) **] - Pt in mild failure by CXR.  Unclear if this was from
tachycardia or preceded admission.  He is on lasix and home.  He
was diuresed based on clincial exam and CXR.
.
Rhythm - He remained in NSR, initially on amio gtt.  Pt
persistently bradycardic overnight.  Event may have been
precipitated by hypoxia.
.
Hypoxia - infection vs CHF.  He was initially treated with
[**Doctor Last Name **]/levo/flagyl.
.
Diabetes - Mr. [**Known lastname 26178**] was placed on an insulin gtt.

Neuro: Mr. [**Known lastname 26178**] [**Last Name (Titles) 3780**] no cranial nerve function,
although he was not apneic. He remained unresponsive and despite
the fact that no sedatives were used on him. After several long
conversations with MR. [**Known lastname 26178**]' children and wife regarding his
poor prognosis, he was made CMO. He was extubated and expired
within hours.

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired
{'Acute respiratory failure,Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Anoxic brain damage,Acute kidney failure, unspecified,Influenza with pneumonia,Unspecified septicemia,Severe sepsis,Septic shock,Grand mal status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}


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: VT arrest

PRESENT ILLNESS: 62 yo male w/ PMHx significant for HTN, hypercholesterolemia,
DM, CRI, and prior V-fib arrest, presented to the ER w/ sob and
cough.  He has been well until yesterday evening when he had a
cough.  Overnight the patient had an episode on non-bloody
emesis.  Today the patient experienced sob and chills and was
[**Last Name (un) 4662**] to the [**Hospital1 18**] ER.

MEDICAL HISTORY: HTN
Diabetes
Vfib arrest [**2-16**]

MEDICATION ON ADMISSION: 

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: Vitals admission - Temp 100.1  BP 159/70  P 85  RR 48  O2 sat
68% RA

FAMILY HISTORY: The patient's mother had [**Name (NI) 2481**].  No other known family
history.  He is a former smoker, quit 30 years ago.  Occasional
alcohol.  He is a retired tailor.  He is married with several
children.

SOCIAL HISTORY:  

### Response:
{'Acute respiratory failure,Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Anoxic brain damage,Acute kidney failure, unspecified,Influenza with pneumonia,Unspecified septicemia,Severe sepsis,Septic shock,Grand mal status,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}
