CHIEF COMPLAINT: Atrial Fibrillation

PRESENT ILLNESS: Mr. [**Known lastname 27735**] is a 67 year old male with past medical history
significant for diabetes, HTN, GERD, and recent pancreatectomy
for necrotizing pancreatitis who presents with nausea,
diaphoresis and new onset atrial fibrillation. The patient was
in his USOH on the morning of admission when he came to the
[**Hospital1 18**] to have his percutaneous cholecystostomy tube removed. He
returned to his rehabilitation facility ([**Hospital 100**] Rehab) without
incident. Shortly after being seen by the physician [**Name Initial (PRE) **] (Dr.
[**Last Name (STitle) **] he began to experience nausea and diaphoresis, which
he experiences fairly frequently since his pancreatectomy. He
then had a 5minute episode of epigastric pain. This was a [**4-3**]
dull ache, that he had never felt before and that he
distinguished as being lower down than the discomfort he
experiences with reflux. The pain did not radiate and was not
accompanied by subjective palpitations or light headedness. At
this time the patient's physician had returned to the room and
his heart rate was noted to be in the 162. Per the NH notes an
EKG demonstrated new ST depressionsin V3-V5 with old TWF in III
and AVF and LVH. Also noteworthy is that the physician at the
nursing home documented the absence of CP, nausea, or
diaphoresis. Patient was sent to the [**Hospital1 18**] via ambulance.

MEDICAL HISTORY: chronic pancreatitis - complicated by pseudocyst. s/p multiple
ERCP's with multiple sphyncterotomies. Now S/P pancreatectomy in
[**2173-2-24**].
Diabetes - recent diagnosis.
HTN
Patient reports recent C.diff diagnosis - per daughter (a
physician) he has been treated.
[**Last Name (un) 865**] esophagus
COPD
h/o MRSA pneumonia
Melanoma s/p removal 15 years ago
Prostate CA - radical prostatectomy in [**2165**]

MEDICATION ON ADMISSION: 1. Acetaminophen 325 mg PO Q4-6H:PRN fever
2. Docusate Sodium (Liquid) 100 mg PO BID
3. Ferrous Sulfate 325 mg PO DAILY
4. Heparin 5000 UNIT SC TID
5. Insulin SC  (per Insulin Flowsheet)      Sliding Scale
6. Lactase *NF* 3,000 unit Oral dialy
7. Lactulose 30 ml PO Q8H:PRN
8. Metoclopramide 10 mg PO QIDACHS
9. Metoprolol 25 mg PO BID
10. Morphine Sulfate 2 mg IV Q4H:PRN
11. Multivitamins 1 CAP PO DAILY
12. Sodium Chloride 2 gm PO DAILY
13. Zolpidem Tartrate 5 mg PO HS

ALLERGIES: Lipitor / Optiray 350

PHYSICAL EXAM: VS: T:97.7 BP:97/51 HR:77 RR:25 O2:1005 on RA
Gen: WDWN elderly male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: [**Name (NI) **] father died of "Heart Disease" at age 51.
[**Name (NI) **] mother died unexpectedly in an automobile accident

SOCIAL HISTORY: significant for the absence of current tobacco use (quit 30
years aog. There is no history of alcohol abuse - drinks [**1-26**]
beers/week.
Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux
Atrial fibrillation,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Esophageal reflux
Admission Date:  [**2173-6-24**]              Discharge Date:   [**2173-6-25**]

Date of Birth:  [**2106-5-8**]             Sex:   M

Service: MEDICINE

Allergies:
Lipitor / Optiray 350

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Atrial Fibrillation

Major Surgical or Invasive Procedure:
D/C Cardioversion


History of Present Illness:
Mr. [**Known lastname 27735**] is a 67 year old male with past medical history
significant for diabetes, HTN, GERD, and recent pancreatectomy
for necrotizing pancreatitis who presents with nausea,
diaphoresis and new onset atrial fibrillation. The patient was
in his USOH on the morning of admission when he came to the
[**Hospital1 18**] to have his percutaneous cholecystostomy tube removed. He
returned to his rehabilitation facility ([**Hospital 100**] Rehab) without
incident. Shortly after being seen by the physician [**Name Initial (PRE) **] (Dr.
[**Last Name (STitle) **] he began to experience nausea and diaphoresis, which
he experiences fairly frequently since his pancreatectomy. He
then had a 5minute episode of epigastric pain. This was a [**4-3**]
dull ache, that he had never felt before and that he
distinguished as being lower down than the discomfort he
experiences with reflux. The pain did not radiate and was not
accompanied by subjective palpitations or light headedness. At
this time the patient's physician had returned to the room and
his heart rate was noted to be in the 162. Per the NH notes an
EKG demonstrated new ST depressionsin V3-V5 with old TWF in III
and AVF and LVH. Also noteworthy is that the physician at the
nursing home documented the absence of CP, nausea, or
diaphoresis. Patient was sent to the [**Hospital1 18**] via ambulance.


Per the EMS record Vital signs were HR 160-180, BP 100/70, EKG
showed SVT. Given 6mg IV adenosine and 15mg IV cardizem.


In the ED the patient's vital signs were HR 160 BP 88/46 RR20
and Sa02 99% on RA. EKG showed Afib with RVR. He was given Dilt
20 IV and 120 PO, fentanyl 25 IV x2, Versed 1mg IV x2,
amiodarone 150mg IV x1 and then 1mg/min gtt, and heparin gtt.
DCCV 50 joules unsuccessful and then 200 joules with resolution
to NSR. CXR performed and CTA deferred [**2-26**] contrast allergy.


Past Medical History:
chronic pancreatitis - complicated by pseudocyst. s/p multiple
ERCP's with multiple sphyncterotomies. Now S/P pancreatectomy in
[**2173-2-24**].
Diabetes - recent diagnosis.
HTN
Patient reports recent C.diff diagnosis - per daughter (a
physician) he has been treated.
[**Last Name (un) 865**] esophagus
COPD
h/o MRSA pneumonia
Melanoma s/p removal 15 years ago
Prostate CA - radical prostatectomy in [**2165**]


Social History:
significant for the absence of current tobacco use (quit 30
years aog. There is no history of alcohol abuse - drinks [**1-26**]
beers/week.

Family History:
[**Name (NI) **] father died of "Heart Disease" at age 51.
[**Name (NI) **] mother died unexpectedly in an automobile accident


Physical Exam:
VS: T:97.7 BP:97/51 HR:77 RR:25 O2:1005 on RA
Gen: WDWN elderly male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

Neck: Supple with JVP flat
CV: PMI located in 5th intercostal space, midclavicular line.
Soft heart sounds. RR, normal S1, S2. No m/r/g. No thrills,
lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Crackles bilaterally at
the bases with right worse than left.
Abd: Soft, NTND. Patient has beefy red 6 inch midline surgical
scar that drained clear fluid. He also has a RUQ dark purulent
drainage tube lesion in the right upper quadrant presumed to be
where the cholecystectomy drain was removed earlier today. No
HSM or tenderness. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
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:
LABS ON ADMISSION:
.

[**2173-6-24**] 04:00PM   WBC-10.5 RBC-3.32* HGB-8.9* HCT-27.2* MCV-82
MCH-26.8* MCHC-32.8 RDW-18.0*
[**2173-6-24**] 04:00PM   cTropnT-0.02*
[**2173-6-24**] 04:00PM   CK(CPK)-13*
[**2173-6-24**] 04:00PM   GLUCOSE-110* UREA N-10 CREAT-0.4* SODIUM-137
POTASSIUM-3.6 CHLORIDE-105 TOTAL CO2-25 ANION GAP-11
[**2173-6-24**] 11:50PM   PTT-150*
[**2173-6-24**] 11:50PM   TSH-2.3
[**2173-6-24**] 11:50PM   CK-MB-NotDone cTropnT-0.07*
[**2173-6-24**] 11:50PM   CK(CPK)-16*
.
ECHO:
The left atrium is normal in size. Left ventricular wall
thicknesses are
normal. The left ventricular cavity size is normal. Overall left
ventricular
systolic function is low normal (LVEF 50-55%). Tissue Doppler
imaging suggests
a normal left ventricular filling pressure (PCWP<12mmHg). Right
ventricular
chamber size and free wall motion are normal. The ascending
aorta is mildly
dilated. The aortic valve leaflets (3) appear structurally
normal with good
leaflet excursion and no aortic regurgitation. The mitral valve
leaflets are
mildly thickened. There is no mitral valve prolapse. Trivial
mitral
regurgitation is seen. The left ventricular inflow pattern
suggests impaired
relaxation. The tricuspid valve leaflets are mildly thickened.
There is a
trivial/physiologic pericardial effusion.

Compared with the prior study (images reviewed) of [**2173-2-15**],
left ventricular
systolic function is now slightly less vigorous.
.
LABS ON DISCHARGE:
[**2173-6-25**] 09:00AM BLOOD WBC-10.4 RBC-3.42* Hgb-9.1* Hct-28.4*
MCV-83 MCH-26.6* MCHC-32.0 RDW-18.4* Plt Ct-685*
[**2173-6-25**] 09:00AM BLOOD Glucose-121* UreaN-8 Creat-0.5 Na-138
K-3.8 Cl-108 HCO3-24 AnGap-10
[**2173-6-25**] 09:00AM BLOOD CK-MB-NotDone cTropnT-0.05*
[**2173-6-25**] 09:00AM BLOOD Albumin-2.4* Calcium-8.6 Phos-3.4 Mg-1.8
Cholest-PND

Brief Hospital Course:
The patient was admitted to the CCU after d/c cardioversion
converted him to Sinus Rhythym. Anticoagulation was begun with
heparin IV. He will be discharged on a heparin drip and not
started on warfarin given possible future surgical procedures.
He remained in sinus rhythym with stable blood pressures. An
echo revealed low-normal EF. Surgery saw the patient who agreed
with a discahrge back to Rehab with surgery follow up. His
primary outpatient cardiologist was called [**2-26**] a patient history
of "fast heart rate" in the past. A message was left and the
patient was encouraged to schedule a follow up appointment with
this cardiologist on discharge. He has close follow up with
surgery and care at [**Hospital 100**] Rehab.


Medications on Admission:
1. Acetaminophen 325 mg PO Q4-6H:PRN fever
2. Docusate Sodium (Liquid) 100 mg PO BID
3. Ferrous Sulfate 325 mg PO DAILY
4. Heparin 5000 UNIT SC TID
5. Insulin SC  (per Insulin Flowsheet)      Sliding Scale
6. Lactase *NF* 3,000 unit Oral dialy
7. Lactulose 30 ml PO Q8H:PRN
8. Metoclopramide 10 mg PO QIDACHS
9. Metoprolol 25 mg PO BID
10. Morphine Sulfate 2 mg IV Q4H:PRN
11. Multivitamins 1 CAP PO DAILY
12. Sodium Chloride 2 gm PO DAILY
13. Zolpidem Tartrate 5 mg PO HS


Discharge Medications:
1. Acetaminophen 325 mg Tablet [**Hospital **]: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed for fever.
2. Metoclopramide 10 mg Tablet [**Hospital **]: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
3. Sodium Chloride 1 g Tablet [**Hospital **]: Two (2) Tablet PO DAILY
(Daily).
4. Hexavitamin     Tablet [**Hospital **]: One (1) Cap PO DAILY (Daily).
5. Lactulose 10 g/15 mL Syrup [**Hospital **]: Thirty (30) ML PO Q8H (every
8 hours) as needed.
6. Zolpidem 5 mg Tablet [**Hospital **]: One (1) Tablet PO HS (at bedtime).

7. Amylase-Lipase-Protease 20,000-4,500- 25,000 unit Capsule,
Delayed Release(E.C.) [**Hospital **]: Two (2) Cap PO TID W/MEALS (3 TIMES A
DAY WITH MEALS).
8. Ferrous Sulfate 325 (65) mg Tablet [**Hospital **]: One (1) Tablet PO BID
(2 times a day).
9. Docusate Sodium 50 mg/5 mL Liquid [**Hospital **]: One (1)  PO BID (2
times a day) as needed.
10. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
11. Metoprolol Tartrate 50 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID
(2 times a day).
12. Insulin Regular Human 100 unit/mL Solution [**Last Name (STitle) **]: 2-10 UNITS
Injection ASDIR (AS DIRECTED): per provided sliding scale.
13. Heparin (Porcine) in D5W 25,000 unit/250 mL Parenteral
Solution [**Last Name (STitle) **]: 1000 (1000) UNITS Intravenous per hour: ADJUST
INFUSION PER SLIDING SCALE.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Atrial Fibrillation with Rapid Ventricular Response
.
chronic pancreatitis - S/P pancreatectomy in [**2173-2-24**].
Diabetes - recent diagnosis.
HTN
Patient reports recent C.diff diagnosis - treated
[**Last Name (un) 865**] esophagus
COPD
h/o MRSA pneumonia
Melanoma s/p removal 15 years ago
Prostate CA - radical prostatectomy in [**2165**]


Discharge Condition:
stable


Discharge Instructions:
Please take all medications as prescribed. Please attend all
follow up appointments. You were admitted because of Atrial
Fibrillation with a Rapid Ventricular Response. You were
succesfully cardioverted. You will need to take blood thinning
medications for some time. You will be taking Lovenox. You will
not be started on warfarin as there may be more surgical
interventions in the future. You will need to discuss with your
surgeons when it will be ok to start coumadin.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 251**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 476**] Date/Time:[**2173-7-5**]
9:30
.
It is recommended that you contact your Cardiologist Dr. [**Last Name (STitle) 5655**]
in [**Location (un) 8545**] @ [**Telephone/Fax (1) 27736**] to set up a follow up appointment
following the discharge from [**Hospital 100**] Rehab.
.
{'Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux'}


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: Atrial Fibrillation

PRESENT ILLNESS: Mr. [**Known lastname 27735**] is a 67 year old male with past medical history
significant for diabetes, HTN, GERD, and recent pancreatectomy
for necrotizing pancreatitis who presents with nausea,
diaphoresis and new onset atrial fibrillation. The patient was
in his USOH on the morning of admission when he came to the
[**Hospital1 18**] to have his percutaneous cholecystostomy tube removed. He
returned to his rehabilitation facility ([**Hospital 100**] Rehab) without
incident. Shortly after being seen by the physician [**Name Initial (PRE) **] (Dr.
[**Last Name (STitle) **] he began to experience nausea and diaphoresis, which
he experiences fairly frequently since his pancreatectomy. He
then had a 5minute episode of epigastric pain. This was a [**4-3**]
dull ache, that he had never felt before and that he
distinguished as being lower down than the discomfort he
experiences with reflux. The pain did not radiate and was not
accompanied by subjective palpitations or light headedness. At
this time the patient's physician had returned to the room and
his heart rate was noted to be in the 162. Per the NH notes an
EKG demonstrated new ST depressionsin V3-V5 with old TWF in III
and AVF and LVH. Also noteworthy is that the physician at the
nursing home documented the absence of CP, nausea, or
diaphoresis. Patient was sent to the [**Hospital1 18**] via ambulance.

MEDICAL HISTORY: chronic pancreatitis - complicated by pseudocyst. s/p multiple
ERCP's with multiple sphyncterotomies. Now S/P pancreatectomy in
[**2173-2-24**].
Diabetes - recent diagnosis.
HTN
Patient reports recent C.diff diagnosis - per daughter (a
physician) he has been treated.
[**Last Name (un) 865**] esophagus
COPD
h/o MRSA pneumonia
Melanoma s/p removal 15 years ago
Prostate CA - radical prostatectomy in [**2165**]

MEDICATION ON ADMISSION: 1. Acetaminophen 325 mg PO Q4-6H:PRN fever
2. Docusate Sodium (Liquid) 100 mg PO BID
3. Ferrous Sulfate 325 mg PO DAILY
4. Heparin 5000 UNIT SC TID
5. Insulin SC  (per Insulin Flowsheet)      Sliding Scale
6. Lactase *NF* 3,000 unit Oral dialy
7. Lactulose 30 ml PO Q8H:PRN
8. Metoclopramide 10 mg PO QIDACHS
9. Metoprolol 25 mg PO BID
10. Morphine Sulfate 2 mg IV Q4H:PRN
11. Multivitamins 1 CAP PO DAILY
12. Sodium Chloride 2 gm PO DAILY
13. Zolpidem Tartrate 5 mg PO HS

ALLERGIES: Lipitor / Optiray 350

PHYSICAL EXAM: VS: T:97.7 BP:97/51 HR:77 RR:25 O2:1005 on RA
Gen: WDWN elderly male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: [**Name (NI) **] father died of "Heart Disease" at age 51.
[**Name (NI) **] mother died unexpectedly in an automobile accident

SOCIAL HISTORY: significant for the absence of current tobacco use (quit 30
years aog. There is no history of alcohol abuse - drinks [**1-26**]
beers/week. 

### Response:
{'Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux'}
