CHIEF COMPLAINT: ICD shocks x 17 today

PRESENT ILLNESS: The patient is a 86 yoM w/ a h/o infarct related cardiomyopathy
and an EF of [**9-10**]% and VT s/p VT ablation and placement of
BiV-ICD + intrathroacic impedence monitor (optivol), atrial
fibrillation on coumadin, CKD, also new diagnosis of multiple
myeloma a few weeks ago presents to ER (initially OSH ER then
transferred to [**Hospital1 18**] ER) for 17 shocks today. His most recent
PPM interrogation revealed an increase in ventricular ectopy and
85 episodes of VT w/ rates 180-190 all successfully treated with
ATP. At this visit he was noted to be mildly volume overloaded
and his lasix dose was increased.

MEDICAL HISTORY: # CAD s/p large anterior MI at age 36;
# 2 vessel CABG [**2101**] LIMA to LAD; SVG to OM
# NSTEMI [**10/2114**] s/p stent to native L circ.
# CHF with LV EF of 25%
# Ventricular Tachycardia: had pacemaker placed in [**2114**] for
primary prevention (MADIT criteria); had [**Hospital1 18**] hospitalization
[**3-26**] (started on amio; d/c'd due to "balance disorder/falls"),
started on procainamide [**12/2116**]; decreased from 1000mg tid to
500mg tid with level 7.2 on [**10-15**].
# s/p [**Company **] [**Last Name (un) **] pacer/defibrillator [**2116-12-31**] (Madit II
criteria)
# atrial flutter: recenty hospitalized at [**Hospital1 18**]
# CRI with baseline Cr in low 2 range
# ???L arm emolism; on coumadin since [**7-/2116**]
# B achilles tendon rupture [**12-24**] ciprofloxacin
# Prostate CA: s/p brachytherapy
# osteoarthritis (currently taking prednisone)
.

MEDICATION ON ADMISSION: digoxin 0.125 three times a week
Lasix 60mg qam and 40 mg qpm (pt states he is taking 80qam and
40qpm)
metoprolol 25 mg daily
prednisone 5 daily
temazepam at night
warfarin
metolazone

ALLERGIES: Ciprofloxacin / Amiodarone / Procainamide / Quinidine

PHYSICAL EXAM: Admission Exam
VS: T 96.3 HR 73 BP 122/58  RR 19  O2 sat 97% on RA
GENERAL: 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: Father died with CAD; healthy son; daughter with [**Name2 (NI) 95740**]

SOCIAL HISTORY: retired; works as volunteer at local hospital. Remote smoking
history, no EtOH
Paroxysmal ventricular tachycardia,Multiple myeloma, without mention of having achieved remission,Chronic kidney disease, Stage IV (severe),Chronic systolic heart failure,Other specified forms of chronic ischemic heart disease,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Long-term (current) use of anticoagulants,Aortocoronary bypass status,Personal history of malignant neoplasm of prostate
Parox ventric tachycard,Mult mye w/o achv rmson,Chr kidney dis stage IV,Chr systolic hrt failure,Chr ischemic hrt dis NEC,Osteoarthros NOS-unspec,Old myocardial infarct,Status autm crd dfbrltr,Long-term use anticoagul,Aortocoronary bypass,Hx-prostatic malignancy
Admission Date:  [**2122-5-8**]              Discharge Date:   [**2122-5-11**]


Service: MEDICINE

Allergies:
Ciprofloxacin / Amiodarone / Procainamide / Quinidine

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
ICD shocks x 17 today

Major Surgical or Invasive Procedure:
None


History of Present Illness:
The patient is a 86 yoM w/ a h/o infarct related cardiomyopathy
and an EF of [**9-10**]% and VT s/p VT ablation and placement of
BiV-ICD + intrathroacic impedence monitor (optivol), atrial
fibrillation on coumadin, CKD, also new diagnosis of multiple
myeloma a few weeks ago presents to ER (initially OSH ER then
transferred to [**Hospital1 18**] ER) for 17 shocks today. His most recent
PPM interrogation revealed an increase in ventricular ectopy and
85 episodes of VT w/ rates 180-190 all successfully treated with
ATP. At this visit he was noted to be mildly volume overloaded
and his lasix dose was increased.

In the [**Hospital1 18**] ER initial VS were: T 97.2 HR 69 BP 101/60 RR 16 O2
sat: 98% on RA. The patients ICD was interrogated by the
cardiology fellow on call who stated it appears all shocks were
appropriate therapies for VT. The patient was given a 150mg IV
bolus of amiodarone and admitted to the CCU. VS prior to
transfer to the CCU were: HR 70 BP 109/65 RR 18 O2 sat 100% on
RA.

Currently feels well, no syncope, no lightheadedness, no SOB, no
DOE, no orthopnea or PND, no chest pain. no fevers / chills. In
general has felt more weak over past 1 month. no numbness or
paresthesias in lower extremities.

On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.

Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

Past Medical History:
# CAD s/p large anterior MI at age 36;
# 2 vessel CABG [**2101**] LIMA to LAD; SVG to OM
# NSTEMI [**10/2114**] s/p stent to native L circ.
# CHF with LV EF of 25%
# Ventricular Tachycardia: had pacemaker placed in [**2114**] for
primary prevention (MADIT criteria); had [**Hospital1 18**] hospitalization
[**3-26**] (started on amio; d/c'd due to "balance disorder/falls"),
started on procainamide [**12/2116**]; decreased from 1000mg tid to
500mg tid with level 7.2 on [**10-15**].
# s/p [**Company **] [**Last Name (un) **] pacer/defibrillator [**2116-12-31**] (Madit II
criteria)
# atrial flutter: recenty hospitalized at [**Hospital1 18**]
# CRI with baseline Cr in low 2 range
# ???L arm emolism; on coumadin since [**7-/2116**]
# B achilles tendon rupture [**12-24**] ciprofloxacin
# Prostate CA: s/p brachytherapy
# osteoarthritis (currently taking prednisone)
.


Social History:
retired; works as volunteer at local hospital. Remote smoking
history, no EtOH


Family History:
Father died with CAD; healthy son; daughter with [**Name2 (NI) 95740**]

Physical Exam:
Admission Exam
VS: T 96.3 HR 73 BP 122/58  RR 19  O2 sat 97% on RA
GENERAL: 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 of 12 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. [**12-28**] HSM at the apex. No thrills, lifts.
No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. rales at L base.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominal bruits.
EXTREMITIES: 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:
[**2122-5-8**] 07:35PM BLOOD WBC-8.3 RBC-5.05 Hgb-14.9 Hct-45.8 MCV-91
MCH-29.6 MCHC-32.6 RDW-15.1 Plt Ct-217
[**2122-5-10**] 02:14AM BLOOD WBC-8.4 RBC-4.71 Hgb-14.7 Hct-43.2 MCV-92
MCH-31.3 MCHC-34.1 RDW-15.4 Plt Ct-192

[**2122-5-8**] 07:35PM BLOOD PT-38.8* PTT-36.3* INR(PT)-3.9*
[**2122-5-9**] 05:03AM BLOOD PT-37.9* PTT-37.2* INR(PT)-3.8*
[**2122-5-10**] 02:14AM BLOOD PT-29.5* PTT-33.5 INR(PT)-2.9*

[**2122-5-8**] 07:35PM BLOOD Glucose-148* UreaN-106* Creat-2.7* Na-135
K-4.4 Cl-90* HCO3-34* AnGap-15
[**2122-5-9**] 05:03AM BLOOD Glucose-194* UreaN-102* Creat-2.5* Na-133
K-3.6 Cl-90* HCO3-31 AnGap-16
[**2122-5-10**] 02:14AM BLOOD Glucose-102* UreaN-104* Creat-2.9* Na-134
K-3.5 Cl-91* HCO3-31 AnGap-16

[**2122-5-8**] 07:35PM BLOOD CK-MB-34* MB Indx-21.7*
[**2122-5-8**] 07:35PM BLOOD cTropnT-0.31*

Brief Hospital Course:
86 year old male with infarct related cardiomyopathy, EF of
[**9-10**]% and VT s/p VT ablation and placement of BiV-ICD +
intrathroacic impedence monitor (optivol), atrial fibrillation
on coumadin, CKD, also new diagnosis of multiple myeloma a few
weeks ago admitted after having 17 ICD shocks.

1. Ventricular tachycardia s/p ICD shocks.  His runs of
sustained and nonsustained monomorphic ventricular tachycardia
subsided once he was amiodarone loaded.  He will be discharged
on amidoarone 400 mg po BID for 13 more days and taper to 200 mg
po qdaily thereafater.

2. Ischemic cardiomyopathy: LVEF of [**9-10**]%. CABG in [**2101**] with
LIMA to LAD and SVG to OM. DES to Lcx in [**2113**].  He was not on
antiplatelet therapy so aspirin 325 mg po qdaily was started.
He was continued on metoprolol succinate 25 mg po qdaily.  He is
not on ACE-I likely due to rise in his creatinine from baseline
due to multiple myeloma.  He is also not on statin as well but
probably appropriate given his age and comorbidities.  He was
continued on home lasix 80 mg po qam and 40 mg po qpm.  His
metalozone was switched to 2.5 mg QOD.

3. Atrial fibrillation. INR supratherapeutic on admission.
Restarted coumadin at lower dose of 1 mg po qdaily especially in
setting of starting amiodarone. Will follow up with PCP this
week for INR check. Continued on metoprolol XL 25 mg po qdaily
for rate control. Discharged on amiodarone 400 mg po BID for
rhythm control for 13 more days and taper to 200 mg po qdaily
thereafter.  Will follow up with EP in one month.

4. Multiple Myeloma. Patient reports having had workup started
as outpatient with bone marrow biopsy and flow cytometry with
oncologist at [**First Name5 (NamePattern1) 745**] [**Last Name (NamePattern1) 18650**]. Follow up with oncologist.

5. Chronic Kidney Disease Stage 4 likely from multiple myeloma.
Follow up with PCP

6. Osteoarthritis/Gout: Continued on uloric and prednisone

Medications on Admission:
digoxin 0.125 three times a week
Lasix 60mg qam and 40 mg qpm (pt states he is taking 80qam and
40qpm)
metoprolol 25 mg daily
prednisone 5 daily
temazepam at night
warfarin
metolazone


Discharge Medications:
1. furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
in the morning
.
2. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
in the evening.
3. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
4. prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. febuxostat 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. temazepam 15 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime) as needed for insomnia.
7. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*90 Tablet(s)* Refills:*2*
8. warfarin 1 mg Tablet Sig: One (1) Tablet PO DAYS
([**Doctor First Name **],MO,TU,WE,TH,FR,SA).
9. metolazone 2.5 mg Tablet Sig: One (1) Tablet PO every other
day: leg edema.
10. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO twice a day
for 13 days: Take 400 mg twice per day until [**2122-5-23**]. Then take
200 mg per day thereafter. .
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] Area VNA

Discharge Diagnosis:
Primary Diagnosis
1. Ventricular tachcardia
2. Ischemic cardiomyopathy with EF of [**9-10**]%


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital after experiencing multiple
ICD shocks for abnormal heart rhythm called ventricular
tachycardia.  You were started on a medication called AMIODARONE
which helped suppress your abnormal rhythm.

FOLLOWING MEDICATION CHANGES WERE MADE TO YOUR MEDICAL REGIMEN
START AMIODARONE 400 mg by mouth twice a day for 13 more days
(end date:[**2122-5-23**]) then switch to 200 mg by mouth daily.
.
We have changed Metolazone from As Needed to Every Other Day
.
START ASPIRIN 325 mg by mouth daily

Followup Instructions:
Name:[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD
Specialty: Primary Care
Address: [**State 8536**], [**Apartment Address(1) 8537**], [**Location (un) **],[**Numeric Identifier 8538**]
Phone: [**Telephone/Fax (1) 40076**]
When: Thursday, [**5-14**] at 9:45am
{'Paroxysmal ventricular tachycardia,Multiple myeloma, without mention of having achieved remission,Chronic kidney disease, Stage IV (severe),Chronic systolic heart failure,Other specified forms of chronic ischemic heart disease,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Long-term (current) use of anticoagulants,Aortocoronary bypass status,Personal history of malignant neoplasm of prostate'}


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: ICD shocks x 17 today

PRESENT ILLNESS: The patient is a 86 yoM w/ a h/o infarct related cardiomyopathy
and an EF of [**9-10**]% and VT s/p VT ablation and placement of
BiV-ICD + intrathroacic impedence monitor (optivol), atrial
fibrillation on coumadin, CKD, also new diagnosis of multiple
myeloma a few weeks ago presents to ER (initially OSH ER then
transferred to [**Hospital1 18**] ER) for 17 shocks today. His most recent
PPM interrogation revealed an increase in ventricular ectopy and
85 episodes of VT w/ rates 180-190 all successfully treated with
ATP. At this visit he was noted to be mildly volume overloaded
and his lasix dose was increased.

MEDICAL HISTORY: # CAD s/p large anterior MI at age 36;
# 2 vessel CABG [**2101**] LIMA to LAD; SVG to OM
# NSTEMI [**10/2114**] s/p stent to native L circ.
# CHF with LV EF of 25%
# Ventricular Tachycardia: had pacemaker placed in [**2114**] for
primary prevention (MADIT criteria); had [**Hospital1 18**] hospitalization
[**3-26**] (started on amio; d/c'd due to "balance disorder/falls"),
started on procainamide [**12/2116**]; decreased from 1000mg tid to
500mg tid with level 7.2 on [**10-15**].
# s/p [**Company **] [**Last Name (un) **] pacer/defibrillator [**2116-12-31**] (Madit II
criteria)
# atrial flutter: recenty hospitalized at [**Hospital1 18**]
# CRI with baseline Cr in low 2 range
# ???L arm emolism; on coumadin since [**7-/2116**]
# B achilles tendon rupture [**12-24**] ciprofloxacin
# Prostate CA: s/p brachytherapy
# osteoarthritis (currently taking prednisone)
.

MEDICATION ON ADMISSION: digoxin 0.125 three times a week
Lasix 60mg qam and 40 mg qpm (pt states he is taking 80qam and
40qpm)
metoprolol 25 mg daily
prednisone 5 daily
temazepam at night
warfarin
metolazone

ALLERGIES: Ciprofloxacin / Amiodarone / Procainamide / Quinidine

PHYSICAL EXAM: Admission Exam
VS: T 96.3 HR 73 BP 122/58  RR 19  O2 sat 97% on RA
GENERAL: 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: Father died with CAD; healthy son; daughter with [**Name2 (NI) 95740**]

SOCIAL HISTORY: retired; works as volunteer at local hospital. Remote smoking
history, no EtOH 

### Response:
{'Paroxysmal ventricular tachycardia,Multiple myeloma, without mention of having achieved remission,Chronic kidney disease, Stage IV (severe),Chronic systolic heart failure,Other specified forms of chronic ischemic heart disease,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Long-term (current) use of anticoagulants,Aortocoronary bypass status,Personal history of malignant neoplasm of prostate'}
