CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 79 year old
female with a past medical history of atrial fibrillation,
supraventricular tachycardia, bradycardia and an episode of
ventricular tachycardia in [**2119**], who presented to her primary
exertion.  The patient had been previously managed on beta
blockers and calcium channel blockers, but her symptoms were
worsening.  She was given a Holter Monitor and returned to
her primary care physician's office where she was complaining
of increased palpitations.  At her primary care physician's
office, her blood pressure was found to be somewhat low and a
subsequently EKG revealed ventricular tachycardia.  She was
work-up.

MEDICAL HISTORY: 1.  Hypertension.
2.  History of atrial fibrillation.
3.  History of supraventricular tachycardia.
4.  History of paroxysmal ventricular tachycardia.
5.  Hypercholesterolemia.
6.  Bradycardia status post permanent pacemaker.
7.  Chronic lower extremity edema.
8.  Degenerative joint disease.
9.  Increased urinary frequency.
10. Fibrocystic breast disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Bactrim.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Unspecified disease of pericardium,Unspecified essential hypertension
Parox ventric tachycard,CHF NOS,Surg compl-heart,Pericardial disease NOS,Hypertension NOS
Admission Date:  [**2137-8-8**]     Discharge Date:  [**2137-8-16**]



HISTORY OF PRESENT ILLNESS:  The patient is a 79 year old
female with a past medical history of atrial fibrillation,
supraventricular tachycardia, bradycardia and an episode of
ventricular tachycardia in [**2119**], who presented to her primary
exertion.  The patient had been previously managed on beta
blockers and calcium channel blockers, but her symptoms were
worsening.  She was given a Holter Monitor and returned to
her primary care physician's office where she was complaining
of increased palpitations.  At her primary care physician's
office, her blood pressure was found to be somewhat low and a
subsequently EKG revealed ventricular tachycardia.  She was
work-up.

At [**Last Name (un) 1724**], she was stable in monomorphic ventricular tachycardia
and essentially asymptomatic.  Attempted cardioversion with
amiodarone was unsuccessful and her ventricular tachycardia
persisted with some increased shortness of breath.  She was
therefore DC cardioverted and transferred to [**Hospital1 346**] for an Electrophysiology study and
potential ventricular tachycardia ablation.

At [**Hospital1 69**], she was taken to the
Electrophysiology Laboratory for attempted ventricular
tachycardia ablation.  The procedure was complicated by
decreased blood pressures to the 80s systolic.  Subsequent
cardiac echocardiogram revealed a 1.5 cm hemodynamically
significant pericardial effusion with right atrial pressures
of around 25 by pulmonary artery catheterization.  She also
had recurrent ventricular tachycardia in the Electrophysiology
Laboratory and was given a Lidocaine drip. Pericardiocentesis was
performed in which we drained approximately 250 cc of blood with
subsequent normalization of blood pressures.

The patient was therefore transferred to the Cardiac Care
Unit where again she experienced a decrease in blood pressures.
An additional amount of fluid was drained.  Her blood pressures
subsequently normalized. In addition, the patient had an elevated
CPK, MB and troponin. Lidocaine was eventually discontinued and
she was switched to amiodarone plus Mexitil and aggressively
diuresed secondary to congestive heart
failure.

She was eventually cardioverted on [**2137-8-13**] from atrial
fibrillation back to normal sinus rhythm.  Today, she was
transferred to the [**Hospital Unit Name 196**] Service for further evaluation.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  History of atrial fibrillation.
3.  History of supraventricular tachycardia.
4.  History of paroxysmal ventricular tachycardia.
5.  Hypercholesterolemia.
6.  Bradycardia status post permanent pacemaker.
7.  Chronic lower extremity edema.
8.  Degenerative joint disease.
9.  Increased urinary frequency.
10. Fibrocystic breast disease.

ALLERGIES:   Bactrim.

MEDICATIONS ON TRANSFER FROM CARDIAC CARE UNIT:
[**Unit Number **].  Aspirin 325 mg p.o. q. daily.
2.  Lasix 20 mg p.o. q. daily.
3.  Lipitor 10 mg p.o. q. daily.
4.  Amiodarone 400 mg p.o. three times a day.
5.  Protonix 40 mg p.o. q. daily.
6.  Colace 100 mg twice a day.
7.  Mexiletine 150 mg three times a day.
8.  Captopril 75 mg p.o. three times a day.
9.  Metoprolol 100 mg p.o. twice a day.
10. Norvasc 10 mg p.o. q. daily.
11. Carvedilol 25 mg twice a day.

PHYSICAL EXAMINATION:  Vital signs revealed 97.4 F.
Temperature; blood pressure 193/90; heart rate paced sinus
rhythm at 74; respiratory rate of 18.   She is [**Age over 90 **]% on two
liters nasal cannula.  In general, she is pleasant, lying in
bed and in no acute distress.  HEENT examination revealed
neck supple; sclerae anicteric.  Increased jugular venous
distention to the ear at 45 degrees.  Cardiovascular
examination revealed an S1 and an S2; regular rate and
rhythm.  I/VI systolic ejection murmur heard mostly at the
left upper sternal border; occasional premature ventricular
contractions.  Distal pulses and radial pulses two plus and
regular.  Lungs with decreased breath sounds at the bases;
otherwise clear to auscultation bilaterally.  Abdomen soft,
nontender, and present bowel sounds.  Extremities:  Markedly
swollen bilaterally.  One to two plus pitting lower extremity
edema; one to two plus pulses bilaterally.  Warm and well
perfused.

LABORATORY:  On transfer, white blood cell count was 8.0,
hematocrit 31.8, platelets 241.  Sodium 139, potassium 3.8,
chloride 101, bicarbonate 28, BUN 14, creatinine 0.8 with
blood glucose of 93.

While in the Cardiac Care Unit, her CK peaked at 336 on
[**8-9**], with a peak MB of 54 and a peak troponin of 40, both
on [**8-8**].  Her current cardiac enzymes are overall down
trending with her last CPK of 53 and her last troponin of
10.7 on [**8-10**].

A previous echocardiogram performed on [**2137-8-9**], showed an
ejection fraction of 40% with mild left atrial enlargement
and right atrial enlargement.  Symmetric mild left
ventricular hypertrophy.  One plus mitral regurgitation and a
trivial pericardial effusion.

HOSPITAL COURSE:  The patient was brought into the [**Hospital Unit Name 196**]
Service for further evaluation.  Because of her elevated
cardiac enzymes, it was decided to perform stress imaging to
determine if the patient had any significant cardiac
ischemia.  A Persantine Sestamibi stress test was performed
on [**2137-8-14**], which was significant for an appropriate heart
rate and blood pressure response, no angina, uninterpretable
EKG; the MIBI portion was significant for no perfusion
defects, no wall motion abnormalities and an ejection
fraction of 60%.

Given the results of the negative stress test, it was
therefore only necessary to better control the patient's
blood pressure.  She was discontinued from her Carvedilol and
her Norvasc was increased from 5 mg p.o. q. daily to 10 mg
p.o. q. daily.  Her blood pressure the next day subsequently
stabilized into the 110s over 70s, and she was overall doing
quite well, ambulating well without any difficulty.

A Physical Therapy consultation was obtained and felt that
she was safe to return home with some occasional Physical
Therapy services.

She will slowly decrease her amiodarone with a new dose on
[**2137-8-16**], of 400 mg p.o. daily.  She will take this for a
total of three weeks and then switch to 200 mg p.o. daily of
amiodarone.  She will also be discharged on [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts
Monitor and follow-up with Dr. [**Last Name (STitle) 284**] in
Electrophysiology Service Clinic in approximately four weeks.
She will also follow-up with her primary care physician in
approximately one week for any adjustment of her blood
pressure medications.

CONDITION AT DISCHARGE:   The patient is ambulating well and
overall is doing quite well.  She was felt to be safe for
discharge.

DISCHARGE STATUS:  To home with Physical Therapy services.

DISCHARGE INSTRUCTIONS:
1.  The patient will follow-up with Dr. [**Last Name (STitle) 4949**], her primary
care physician, [**Name10 (NameIs) **] [**8-23**], at 10:45 a.m.
2.  She will also follow-up with Dr. [**Last Name (STitle) 284**] in
approximately four weeks on the results of her [**Doctor Last Name **] of Hearts
Monitor which she will be discharged home on today.
3.  In addition she will follow up with Dr. [**Last Name (STitle) 44150**] of
cardiology at [**Last Name (un) 1724**].

DISCHARGE MEDICATIONS:
1.  Lasix 20 mg p.o. q. daily.
2.  Lisinopril 40 mg p.o. q. daily.
3.  Lipitor 10 mg p.o. q. daily.
4.  Ranitidine 150 mg p.o. q. daily.
5.  Aspirin 325 mg p.o. q. daily.
6.  Metoprolol 100 mg p.o. three times a day.
7.  Amiodarone 400 mg p.o. q. daily for three weeks; then 200
mg p.o. q. daily starting on [**2137-9-6**].
8.  Mexiletine 150 mg p.o. three times a day.
9.  Norvasc 10 mg p.o. q. daily.

DISCHARGE DIAGNOSES:
1.  Recurrent paroxysmal ventricular tachycardia status post
unsuccessful ventricular tachycardia ablation.
2.  Paroxysmal atrial fibrillation.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Bradycardia status post permanent pacemaker.
6.  Chronic lower extremity edema.
7.  Degenerative joint disease.
8.  Pericardial tamponade complicating EPS, treated with
pericardiocentesis.



                          [**First Name4 (NamePattern1) 610**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3812**]

Dictated By:[**Name8 (MD) 44151**]
MEDQUIST36

D:  [**2137-8-20**]  20:55
T:  [**2137-8-26**]  15:05
JOB#:  [**Job Number 44152**]
{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Unspecified disease of pericardium,Unspecified essential hypertension'}


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 a 79 year old
female with a past medical history of atrial fibrillation,
supraventricular tachycardia, bradycardia and an episode of
ventricular tachycardia in [**2119**], who presented to her primary
exertion.  The patient had been previously managed on beta
blockers and calcium channel blockers, but her symptoms were
worsening.  She was given a Holter Monitor and returned to
her primary care physician's office where she was complaining
of increased palpitations.  At her primary care physician's
office, her blood pressure was found to be somewhat low and a
subsequently EKG revealed ventricular tachycardia.  She was
work-up.

MEDICAL HISTORY: 1.  Hypertension.
2.  History of atrial fibrillation.
3.  History of supraventricular tachycardia.
4.  History of paroxysmal ventricular tachycardia.
5.  Hypercholesterolemia.
6.  Bradycardia status post permanent pacemaker.
7.  Chronic lower extremity edema.
8.  Degenerative joint disease.
9.  Increased urinary frequency.
10. Fibrocystic breast disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Bactrim.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Unspecified disease of pericardium,Unspecified essential hypertension'}
