CHIEF COMPLAINT: Hypotension

PRESENT ILLNESS: Mr. [**Known lastname 16585**] is a 76M with PMH significant for CVA and HTN who
presented to the ED with a several hour history of
uncontrollable diarrhea after playing golf and drinking during
the day. He also experienced generalized body aches. Of note, he
does had h/o stable angina, and has had to use SL NTG over last
couple of days due to CP. He stated, however, that his current
body aches were not similar to his usual anginal symptoms.
Initial evaluation by EMS found a cool, pale, diaphoretic pt,
with BP 80/p, HR 37, junctional with retrograde P waves. He was
given IVF, and atropine 0.5mg x 2 with HR increasing to 49, but
still with BP 80/p. External pacing was atttempted at 70bpm at
80mA, increasing BP to 100/p, but capture lost, and unable to
regain capture after increasing mA to 100.

MEDICAL HISTORY: HTN
normal pMIBI [**2145**] with estimated EF 54%. H/o positive stress
test [**2138**] demonstrating reversible inferior and posterior
changes. No intervention.
h/o CVA [**2138**]
Carotid stenosis s/p R CEA
Gout
LBP s/p L4-5 laminectomy

MEDICATION ON ADMISSION: Lipitor 10mg PO qD
Quinine 325mg PO qHS prn leg cramps
Atenolol 50mg PO bid
Diltiazem CD
Allopurinol 300mg PO qD
Lisinopril 5mg PO qD
Nitro patch
ASA 325mg PO qD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 94.0F  BP: 107/50  HR: 70  RR: 26
Vent: AC 600 x 14 (+ 11 spontaneous)/5/100% FIO2
Gen: Intubated, sedated
HEENT: PERRL, MMM
Neck: Scar from R CEA visible, JVP 11cm
CV: RRR, nl S1 and S2, no m/r/g
Chest: Rhoncorous breath sounds anteriorly
Abd: Soft, ND, no HSM, hypoactive BS
Extr: 1+ LE edema, tr DPs bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: 110 pack-year hx, quit [**2136**], signfificant EtOH intake (1 case
beer/week). No h/o drug use.
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery
Subendo infarct, initial,Acute kidney failure NOS,Crnry athrscl natve vssl
Admission Date:  [**2148-5-14**]              Discharge Date:   [**2148-5-25**]

Date of Birth:  [**2072-3-28**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Hypotension

Major Surgical or Invasive Procedure:
[**2148-5-15**] Cardiac catheterization
[**2148-5-20**] Off Pump Coronary Artery Bypass Grafting utilizing
saphenous vein graft to obtuse marginal artery


History of Present Illness:
Mr. [**Known lastname 16585**] is a 76M with PMH significant for CVA and HTN who
presented to the ED with a several hour history of
uncontrollable diarrhea after playing golf and drinking during
the day. He also experienced generalized body aches. Of note, he
does had h/o stable angina, and has had to use SL NTG over last
couple of days due to CP. He stated, however, that his current
body aches were not similar to his usual anginal symptoms.
Initial evaluation by EMS found a cool, pale, diaphoretic pt,
with BP 80/p, HR 37, junctional with retrograde P waves. He was
given IVF, and atropine 0.5mg x 2 with HR increasing to 49, but
still with BP 80/p. External pacing was atttempted at 70bpm at
80mA, increasing BP to 100/p, but capture lost, and unable to
regain capture after increasing mA to 100.

Past Medical History:
HTN
normal pMIBI [**2145**] with estimated EF 54%. H/o positive stress
test [**2138**] demonstrating reversible inferior and posterior
changes. No intervention.
h/o CVA [**2138**]
Carotid stenosis s/p R CEA
Gout
LBP s/p L4-5 laminectomy

Social History:
110 pack-year hx, quit [**2136**], signfificant EtOH intake (1 case
beer/week). No h/o drug use.

Family History:
NC

Physical Exam:
T: 94.0F  BP: 107/50  HR: 70  RR: 26
Vent: AC 600 x 14 (+ 11 spontaneous)/5/100% FIO2
Gen: Intubated, sedated
HEENT: PERRL, MMM
Neck: Scar from R CEA visible, JVP 11cm
CV: RRR, nl S1 and S2, no m/r/g
Chest: Rhoncorous breath sounds anteriorly
Abd: Soft, ND, no HSM, hypoactive BS
Extr: 1+ LE edema, tr DPs bilaterally


Pertinent Results:
[**2148-5-14**] 08:55PM BLOOD WBC-9.9 RBC-4.53* Hgb-13.0* Hct-38.0*
MCV-84 MCH-28.7 MCHC-34.1 RDW-13.3 Plt Ct-270
[**2148-5-14**] 08:55PM BLOOD Glucose-117* UreaN-37* Creat-3.1*# Na-134
K-5.6* Cl-100 HCO3-15* AnGap-25*
[**2148-5-14**] 08:55PM BLOOD ALT-21 AST-35 LD(LDH)-211 CK(CPK)-112
AlkPhos-74 Amylase-88 TotBili-0.3
[**2148-5-14**] 08:55PM BLOOD CK-MB-2 cTropnT-<0.01
[**2148-5-14**] 08:55PM BLOOD TSH-4.0
[**2148-5-15**] 07:00AM BLOOD Cortsol-15.0
[**2148-5-14**] 08:55PM BLOOD ASA-NEG Ethanol-84* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2148-5-14**] 09:01PM BLOOD Lactate-5.1* K-5.5*
[**2148-5-22**] 07:35AM BLOOD WBC-9.9 RBC-3.74* Hgb-10.8* Hct-31.5*
MCV-84 MCH-28.8 MCHC-34.3 RDW-14.1 Plt Ct-161
[**2148-5-23**] 05:30AM BLOOD Glucose-105 UreaN-11 Creat-1.2 Na-137
K-3.9 Cl-99 HCO3-28 AnGap-14
[**2148-5-23**] 05:30AM BLOOD Calcium-8.4 Phos-3.2 Mg-1.9

Brief Hospital Course:
He arrived to the ED minimally responsive, withdrawing to pain
with attempts to externally pace continuing. He was intubated,
and R SC cordis and R a-line placed, and was started on dopamine
gtt. Cardiology fellow performed carotid massage, after which pt
spontaneously reverted to NSR with HR 60s. Subsequent ECG
demonstrated new ST depressions in V2-V6 (most notable in
V3-V5), with 1mm STE in III, 0.5mm STE in II and AVF, and some
suggestion of possible STE in AVR. Initial CK was 112 with MB 2,
and tropT of <0.01. He was given ASA 600mg PR. Initial labs were
notable for BUN/Cr of 37/3.1, from likely baseline around 1.4.
wbc was 9.9 with no left shift. K was elevated to 5.6. Bicarb
was 15, with initial ABG 7.17/37/286/14, lactate 4.0. Pt
remained hypotensive on Dopamine 50mcg/kg/min, and was switched
to Levophed 0.05mcg/kg/min. Pupils were noted to be fixed and
dilated. Had stat head CT, which did not show any evidence of
acute hemorrhage or mass effect, with probable maintenance of
[**Doctor Last Name 352**]-white differentiation. CXR at 10pm suggested possible
increasing pulmonary vasculature which was not present on
initial 9pm CXR. He also had a non-contrast chest/abd CT, which
was notable for bilateral dependent consolidations and small
pleural effusions, with increased ground glass opacities
bilaterally. There was possible peripancreatic stranding, but no
dilated loops of bowel and a normal-appearing appendix. Initial
LFTs, amylase, and lipase were unremarkable. He was transferred
to the CCU intubated on Levophed for further management. Given
concern for sepsis, borad spectrum antibiotics were initiated.
In the CCU, a bedside TTE was done by cardiology fellow which
demonstrated relatively preserved EF. Cardiac enzymes eventually
rose, peaking at Troponin of 3.0 and CK-MB of 103. Subsequent
cardiac cath on [**5-15**] showed proximal 40% LAD lesion, 70% ostial
lesion in the circumflex and a diffusely diseased RCA. PCI of
the RCA was considered but due to the small caliber vessel,
renal failure and possible septic process, it was initially
decided to continue with medical therapy. Patient remained
intubated and required full ventilatory support. Septic workup
eventually returned negative. Over several days, his renal
function normalized and he was eventually extubated. Despite
aggressive medical therapy, he continued to experience anginal
symptoms with lateral ST depressions which improved with Nitro
drip. Cardiac surgery was therefore consulted for coronary
revascularization surgery and further evaluation was performed.
Carotid ultrasound revealed moderate disease of his left
internal carotid artery. Workup was otherwise benign. Given his
improving renal function and no evidence of sepsis, he was
eventually cleared for surgery. On [**5-20**], Dr. [**Last Name (STitle) **]
performed off pump coronary artery bypass grafting. For surgical
details, please see seperate dictated operative note. Following
the operation, he was brought to the CSRU for invasive
monitoring. Within 24 hours, he awoke neurologically intact and
was extubated without incident. He maintained stable
hemodynamics as he weaned from inotropic support.  On
postoperative day one, he transferred to the SDU. Beta blockade
was slowly advanced as tolerated. He remained in a normal sinus
rhythm without evidence of atrial or ventricular arrhythmias.
Empiric antibiotics were eventually discontinued. Over several
days, he continued to make clinical improvements with medical
therapy and made steady progress with physical therapy. The rest
of his postop course was unremarkable and he was medically
cleared for discharge on postoperative day five.

Medications on Admission:
Lipitor 10mg PO qD
Quinine 325mg PO qHS prn leg cramps
Atenolol 50mg PO bid
Diltiazem CD
Allopurinol 300mg PO qD
Lisinopril 5mg PO qD
Nitro patch
ASA 325mg PO qD

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
5 days.
Disp:*5 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO once a day for 5 days.
Disp:*10 Capsule, Sustained Release(s)* Refills:*0*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary artery disease s/p Off Pump CABG
Acute MI
Hypotension with bradycardia
Preoperative Acute Respiratory Failure
Preoperative Acute Renal Failure
HTN
CVA [**2138**]
Carotid disease, moderate [**Doctor First Name 3098**] stenosis and s/p R CEA
Gout
LBP s/p L4-5 laminectomy


Discharge Condition:
Satisfactory


Discharge Instructions:
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs for 2 months.
Shower daily, let the water flow over wnds, and pat dry with a
towel.
Do not use lotions, creams , or powders on wounds.
Call our office with Temp>101.5, sternal drainage.

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) **] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) **] for 4 weeks.



Completed by:[**2148-6-6**]
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery'}


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: Hypotension

PRESENT ILLNESS: Mr. [**Known lastname 16585**] is a 76M with PMH significant for CVA and HTN who
presented to the ED with a several hour history of
uncontrollable diarrhea after playing golf and drinking during
the day. He also experienced generalized body aches. Of note, he
does had h/o stable angina, and has had to use SL NTG over last
couple of days due to CP. He stated, however, that his current
body aches were not similar to his usual anginal symptoms.
Initial evaluation by EMS found a cool, pale, diaphoretic pt,
with BP 80/p, HR 37, junctional with retrograde P waves. He was
given IVF, and atropine 0.5mg x 2 with HR increasing to 49, but
still with BP 80/p. External pacing was atttempted at 70bpm at
80mA, increasing BP to 100/p, but capture lost, and unable to
regain capture after increasing mA to 100.

MEDICAL HISTORY: HTN
normal pMIBI [**2145**] with estimated EF 54%. H/o positive stress
test [**2138**] demonstrating reversible inferior and posterior
changes. No intervention.
h/o CVA [**2138**]
Carotid stenosis s/p R CEA
Gout
LBP s/p L4-5 laminectomy

MEDICATION ON ADMISSION: Lipitor 10mg PO qD
Quinine 325mg PO qHS prn leg cramps
Atenolol 50mg PO bid
Diltiazem CD
Allopurinol 300mg PO qD
Lisinopril 5mg PO qD
Nitro patch
ASA 325mg PO qD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 94.0F  BP: 107/50  HR: 70  RR: 26
Vent: AC 600 x 14 (+ 11 spontaneous)/5/100% FIO2
Gen: Intubated, sedated
HEENT: PERRL, MMM
Neck: Scar from R CEA visible, JVP 11cm
CV: RRR, nl S1 and S2, no m/r/g
Chest: Rhoncorous breath sounds anteriorly
Abd: Soft, ND, no HSM, hypoactive BS
Extr: 1+ LE edema, tr DPs bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: 110 pack-year hx, quit [**2136**], signfificant EtOH intake (1 case
beer/week). No h/o drug use. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery'}
