CHIEF COMPLAINT: bradycardia

PRESENT ILLNESS: Mr [**Known lastname **] is a 63 year old gentleman with recent CABG x 2 and
MVR (OnX mechanical valve)/ MAZE/PFO closure admitted for
hypotension and bradycardia s/p DC cardioversion for
aflutter/atach. Per [**Name (NI) **], pt was recently admitted in [**2149-4-5**]
for subtherapeutic INR. During that admission, he was found to
be in aflutter. At that time he was on Toprol Xl and amiodarone.
Per the patient, amiodarone was then discontinued. Given his
multiple recent surgeries, DC cardioversion was thought to be
the best option for rhythm control. The patient himself has not
had symptoms of tachycardia, no CP, no SOB.
.
The patient underwent DC cardioversion with sedation. He then
became hypotensive and was bradycardic in a junctional rythm. He
was placed on dopamine and recovered his blood pressure. He was
subsequently admitted to the ICU for observation. Currently he
states that he felt dizzy after cardioversion, but now feels
well.

MEDICAL HISTORY: [**1-14**] complex cardiac surgery:
-- artifical MV placed
-- Coronary Artery Bypass Graft x 2 (LIMA to LAD, SVG to Diag)
-- Patent Foramen Ovale closure
-- [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1916**] ligation
-- MAZE procedure
Atrial Fibrillation
Endocarditis - source thought to be dental abscesses
Chronic Obstructive Pulmonary Disease
Asthma
Gout
Anxiety
s/p cataract surgery

MEDICATION ON ADMISSION: Aspirin 81mg daily
Ranitidine 150mg [**Hospital1 **]
Toprol xl 75mg daily
Lasix 40mg daily
Multivitamin daily
Singulair 10mg daily
Coumadin as per the [**Hospital 18**] [**Hospital 197**] clinic
Lipitor 20mg daily
Colace 100mg PRN
[**Doctor First Name **] 180mg daily
Ambien 10mg PRN for sleep
Albuterol inhaler
Advair disc 250-50 1 disc twice a day
Colchicine prn for gout flares
Spiriva inhaler daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: afebrile BP 114/89 HR 83 R 14 Sao2 97% RA
GEN: well appearing in NAD
HEENT: no JVD
CVS: well healed, midline chest scar RRR, mechanical S2, [**3-12**]
diastolic murmur
Resp: CTAB, no labored breathing
EXT: no edema
Neuro: Aox3

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking in [**10/2148**] after 2ppd x 50yrs. Denies ETOH use.
Hypotension, unspecified,Systolic heart failure, unspecified,Chronic obstructive asthma, unspecified,Atrial flutter,Heart valve replaced by other means,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Dysthymic disorder
Hypotension NOS,Systolic hrt failure NOS,Chronic obst asthma NOS,Atrial flutter,Heart valve replac NEC,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hypertension NOS,Dysthymic disorder
Admission Date:  [**2149-5-27**]              Discharge Date:   [**2149-6-3**]

Date of Birth:  [**2085-5-14**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 458**]
Chief Complaint:
bradycardia

Major Surgical or Invasive Procedure:
Cardioversion


History of Present Illness:
Mr [**Known lastname **] is a 63 year old gentleman with recent CABG x 2 and
MVR (OnX mechanical valve)/ MAZE/PFO closure admitted for
hypotension and bradycardia s/p DC cardioversion for
aflutter/atach. Per [**Name (NI) **], pt was recently admitted in [**2149-4-5**]
for subtherapeutic INR. During that admission, he was found to
be in aflutter. At that time he was on Toprol Xl and amiodarone.
Per the patient, amiodarone was then discontinued. Given his
multiple recent surgeries, DC cardioversion was thought to be
the best option for rhythm control. The patient himself has not
had symptoms of tachycardia, no CP, no SOB.
.
The patient underwent DC cardioversion with sedation. He then
became hypotensive and was bradycardic in a junctional rythm. He
was placed on dopamine and recovered his blood pressure. He was
subsequently admitted to the ICU for observation. Currently he
states that he felt dizzy after cardioversion, but now feels
well.


Past Medical History:
[**1-14**] complex cardiac surgery:
-- artifical MV placed
-- Coronary Artery Bypass Graft x 2 (LIMA to LAD, SVG to Diag)
-- Patent Foramen Ovale closure
-- [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1916**] ligation
-- MAZE procedure
Atrial Fibrillation
Endocarditis - source thought to be dental abscesses
Chronic Obstructive Pulmonary Disease
Asthma
Gout
Anxiety
s/p cataract surgery

Social History:
Quit smoking in [**10/2148**] after 2ppd x 50yrs. Denies ETOH use.


Family History:
Non-contributory

Physical Exam:
Vitals: afebrile BP 114/89 HR 83 R 14 Sao2 97% RA
GEN: well appearing in NAD
HEENT: no JVD
CVS: well healed, midline chest scar RRR, mechanical S2, [**3-12**]
diastolic murmur
Resp: CTAB, no labored breathing
EXT: no edema
Neuro: Aox3


Pertinent Results:
[**2149-5-27**] 09:54PM BLOOD WBC-10.4 RBC-4.83 Hgb-13.6* Hct-40.5
MCV-84 MCH-28.1 MCHC-33.6 RDW-16.8* Plt Ct-254
[**2149-5-29**] 04:10AM BLOOD WBC-8.7 RBC-4.15* Hgb-11.9*# Hct-34.7*
MCV-84 MCH-28.8# MCHC-34.4# RDW-16.7* Plt Ct-225#
[**2149-5-27**] 09:54PM BLOOD Neuts-68.3 Lymphs-24.1 Monos-6.1 Eos-1.1
Baso-0.4
[**2149-5-27**] 12:10PM BLOOD INR(PT)-2.0*
[**2149-5-28**] 06:00AM BLOOD PT-13.7* PTT-21.6* INR(PT)-1.2*
[**2149-5-29**] 04:10AM BLOOD PT-22.6* PTT-63.7* INR(PT)-2.2*
[**2149-5-27**] 09:54PM BLOOD Glucose-133* UreaN-21* Creat-1.1 Na-141
K-3.8 Cl-104 HCO3-30 AnGap-11
[**2149-5-29**] 04:10AM BLOOD Glucose-95 UreaN-17 Creat-0.8 Na-142
K-4.2 Cl-107 HCO3-26 AnGap-13
[**2149-5-28**] 06:00AM BLOOD CK(CPK)-54
[**2149-5-28**] 06:00AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2149-5-27**] 09:54PM BLOOD Calcium-9.0 Phos-3.7 Mg-2.0
[**2149-5-29**] 04:10AM BLOOD Calcium-8.9 Phos-2.8 Mg-2.1

Brief Hospital Course:
This 69 year old gentleman with a history of afib, COPD and
endocarditis underwent CABG x 2, mechanical MVR, closure of
patent foramen ovale, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1916**] ligation and MAZE procedure
on [**2149-1-13**] s/p DC cardioversion with subsequent hypotension and
bradycardia.
.
# Rhythm: The patient was admitted with afib/flutter for DC
cardioversion. After cardioversion the patient was hypotensive
to SBp 80's and bradycardic with a junctional rhythm of 40's. He
was placed on dopamine. Just after cardioversion, he felt dizzy
but was assymptomatic from then on. He was weaned off the
dopamine. Intially, he remained in a junctional rythm but he
sinus node then recovered to a sinus bradycardia with occaisonal
pauses. He was able to increase his HR to 60's with walking and
did not feel lightheaded or weak with excercise. Pacemaker
implantation was discussed with the pt who declined and strongly
desired to avoid device implantation.  His beta blocker was
stopped.
.
# Valves: Prosthetic Mitral Valve, no acute issues. His goal INR
is 2.5-3.5. Heparin gtt was started with a low INR and coumadin
held in setting of possible pacemaker placement. Coumadin was
restarted when it was decided not to place a pacemaker. He was
kept in hospital on heparin until his INR reached 2.5; it
reached 2.6 on the day of discharge.
.
# CAD/Ischemia: no acute issues. He was maintained on ASA and
statin. BB was discontinued.
.
# Pump: Mild chronic systolic heart failure at baseline w/o
exacerbation. No signs of fluid overload on exam. Intially lasix
was held in the setting of hypotesion. It was restarted when his
blood pressure recovered.
- holding lasix and BB in setting of hypotension
.
# COPD: No excerbation. The patient was maintained on home
regimen.
.
#Contact: [**Name (NI) 553**] [**Last Name (NamePattern1) 174**] (Friend) [**Telephone/Fax (1) 9003**]


Medications on Admission:
Aspirin 81mg daily
Ranitidine 150mg [**Hospital1 **]
Toprol xl 75mg daily
Lasix 40mg daily
Multivitamin daily
Singulair 10mg daily
Coumadin as per the [**Hospital 18**] [**Hospital 197**] clinic
Lipitor 20mg daily
Colace 100mg PRN
[**Doctor First Name **] 180mg daily
Ambien 10mg PRN for sleep
Albuterol inhaler
Advair disc 250-50 1 disc twice a day
Colchicine prn for gout flares
Spiriva inhaler daily


Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*0*
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*2*
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*90 Tablet(s)* Refills:*2*
5. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
Disp:*180 Capsule(s)* Refills:*0*
7. Fexofenadine 60 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*270 Tablet(s)* Refills:*2*
8. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed. Tablet(s)
9. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
Disp:*3 inhalers* Refills:*0*
10. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*3 Disk with Device(s)* Refills:*2*
11. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*90 caps* Refills:*2*
12. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*2*
13. Warfarin 2.5 mg Tablet Sig: Three (3) Tablet PO DAILY16
(Once Daily at 16).
Disp:*90 Tablet(s)* Refills:*2*
14. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
Disp:*90 Tablet(s)* Refills:*0*
15. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*90 Tablet(s)* Refills:*2*
16. Outpatient Lab Work
Please check INR and notify the [**Company 191**] coumadin clinic of results.


Discharge Disposition:
Home

Discharge Diagnosis:
atrial fibrillation/Atrial Flutter
Junctional Rhythm
Bradycardia
Hypotension
Hypertension
anticoagulation for mechanical valve


Discharge Condition:
Good. Ambulating, afebrile, tolerating PO.


Discharge Instructions:
You were admitted to the hospital to undergo a procedure which
would eliminate your atrial fibrillation. After the procedure,
your heart rate was extremely low and you needed to be
transferred to the CCU for closer monitoring. Over 48 hours,
your heart rate gradually increased.
.
Please take your medications as prescribed. Please do not take
your metoprolol XL (toprol XL) because this will slow your heart
rate even further. Your doctors [**Name5 (PTitle) **] [**Name5 (PTitle) 9004**] to restart this
medication at some point later.  You were started on a new blood
pressure medication called lisinopril.
.
You should have your INR checked on Thursday [**2149-6-5**] and
sent to your coumadin clinic/PCP [**Name Initial (PRE) 3726**].
.
Please follow-up as described below.

Please see your PCP or go to the emergency room if you have
fevers over 102, chills, chest pain, trouble breathing,
lightheadedness or any other symptoms which are concerning to
you.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 9001**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2149-6-10**] 2:40
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 5003**]
Date/Time:[**2149-6-17**] 1:40 PM
Provider: [**Name10 (NameIs) 6821**] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 1971**] Date/Time:[**2149-9-23**]
9:45
.
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], cardiology: make an appointment in
six months by calling [**Telephone/Fax (1) 285**].
{'Hypotension, unspecified,Systolic heart failure, unspecified,Chronic obstructive asthma, unspecified,Atrial flutter,Heart valve replaced by other means,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Dysthymic disorder'}


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: bradycardia

PRESENT ILLNESS: Mr [**Known lastname **] is a 63 year old gentleman with recent CABG x 2 and
MVR (OnX mechanical valve)/ MAZE/PFO closure admitted for
hypotension and bradycardia s/p DC cardioversion for
aflutter/atach. Per [**Name (NI) **], pt was recently admitted in [**2149-4-5**]
for subtherapeutic INR. During that admission, he was found to
be in aflutter. At that time he was on Toprol Xl and amiodarone.
Per the patient, amiodarone was then discontinued. Given his
multiple recent surgeries, DC cardioversion was thought to be
the best option for rhythm control. The patient himself has not
had symptoms of tachycardia, no CP, no SOB.
.
The patient underwent DC cardioversion with sedation. He then
became hypotensive and was bradycardic in a junctional rythm. He
was placed on dopamine and recovered his blood pressure. He was
subsequently admitted to the ICU for observation. Currently he
states that he felt dizzy after cardioversion, but now feels
well.

MEDICAL HISTORY: [**1-14**] complex cardiac surgery:
-- artifical MV placed
-- Coronary Artery Bypass Graft x 2 (LIMA to LAD, SVG to Diag)
-- Patent Foramen Ovale closure
-- [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1916**] ligation
-- MAZE procedure
Atrial Fibrillation
Endocarditis - source thought to be dental abscesses
Chronic Obstructive Pulmonary Disease
Asthma
Gout
Anxiety
s/p cataract surgery

MEDICATION ON ADMISSION: Aspirin 81mg daily
Ranitidine 150mg [**Hospital1 **]
Toprol xl 75mg daily
Lasix 40mg daily
Multivitamin daily
Singulair 10mg daily
Coumadin as per the [**Hospital 18**] [**Hospital 197**] clinic
Lipitor 20mg daily
Colace 100mg PRN
[**Doctor First Name **] 180mg daily
Ambien 10mg PRN for sleep
Albuterol inhaler
Advair disc 250-50 1 disc twice a day
Colchicine prn for gout flares
Spiriva inhaler daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: afebrile BP 114/89 HR 83 R 14 Sao2 97% RA
GEN: well appearing in NAD
HEENT: no JVD
CVS: well healed, midline chest scar RRR, mechanical S2, [**3-12**]
diastolic murmur
Resp: CTAB, no labored breathing
EXT: no edema
Neuro: Aox3

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking in [**10/2148**] after 2ppd x 50yrs. Denies ETOH use. 

### Response:
{'Hypotension, unspecified,Systolic heart failure, unspecified,Chronic obstructive asthma, unspecified,Atrial flutter,Heart valve replaced by other means,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Dysthymic disorder'}
