CHIEF COMPLAINT: S/P cardiac arrest

PRESENT ILLNESS: 68 YOM with unknonw PMH found at the back of loading truck for
unknown amount of time by friends. AED placed and shock
indicated. NO rhythm strip. Had agonal breaths. EMS Arrived. No
more shocks aDVISED. ems SAID "BIZZARE WIDE COMPLEX" and
tachycardic. Went to OSH ([**Hospital1 2436**]) intubated and coold.
Continued to have wide complex tachy. Got ami x2 with amio gtt.
Life flight arrived and he was in NSR with LBBB.
.
Patient was Kept on Amio Gtt when arrived. A CXR showed RUL
consolidation which was interpreted as possible pulmonary
contusion. There was a concern for aspiration and started on
Levo and flagyl.
.
After discussion with the family he apparently had a cardiac
catheterization sometime in the last month at the [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 669**] VA
for unknown reasons. His wife reports that there were "some
plaques" but nothing to put stents in. Incidentally he was found
to have a pulmonary nodule and a CT was reccomended. He refused
at the time and was scheduled to have scan in one month.
.
In the ED he is intubated and sedated. Cooling procol was
initiated.
.
REVIEW OF SYSTEMS
Deferred as patient is intubated and sedated

MEDICAL HISTORY: Nonischemic cardiomyopathy with severely reduced lv systolic
function
HTN
Tobacco dependance
Nephrolithiasis
LBBB

MEDICATION ON ADMISSION: MEDICATIONS:
Lisinopril 20mg QD
Metoprolol 200mg QD
Warfarin 2mg QD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: 50 Pack year history
-ETOH: Occasional
-Illicit drugs: Drugs
Paroxysmal ventricular tachycardia,Cardiogenic shock,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Other pneumothorax,Other primary cardiomyopathies,Precipitous drop in hematocrit,Acidosis,Personal history of sudden cardiac arrest,Other accidental fall from one level to another,Contusion of orbital tissues,Unspecified essential hypertension,Tobacco use disorder,Coronary atherosclerosis of native coronary artery,Neoplasm of uncertain behavior of trachea, bronchus, and lung,Other left bundle branch block,Calculus of kidney,Anticoagulants causing adverse effects in therapeutic use
Parox ventric tachycard,Cardiogenic shock,Pneumonia, organism NOS,Food/vomit pneumonitis,Ac systolic hrt failure,Other pneumothorax,Prim cardiomyopathy NEC,Drop, hematocrit, precip,Acidosis,Hx sudden cardiac arrest,Fall-1 level to oth NEC,Contusion orbital tissue,Hypertension NOS,Tobacco use disorder,Crnry athrscl natve vssl,Unc behav neo lung,Left bb block NEC,Calculus of kidney,Adv eff anticoagulants
Admission Date:  [**2168-7-7**]              Discharge Date:   [**2168-7-19**]

Date of Birth:  [**2099-11-1**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2901**]
Chief Complaint:
S/P cardiac arrest

Major Surgical or Invasive Procedure:
Lung biopsy [**2168-7-18**]

History of Present Illness:
68 YOM with unknonw PMH found at the back of loading truck for
unknown amount of time by friends. AED placed and shock
indicated. NO rhythm strip. Had agonal breaths. EMS Arrived. No
more shocks aDVISED. ems SAID "BIZZARE WIDE COMPLEX" and
tachycardic. Went to OSH ([**Hospital1 2436**]) intubated and coold.
Continued to have wide complex tachy. Got ami x2 with amio gtt.
Life flight arrived and he was in NSR with LBBB.
.
Patient was Kept on Amio Gtt when arrived. A CXR showed RUL
consolidation which was interpreted as possible pulmonary
contusion. There was a concern for aspiration and started on
Levo and flagyl.
.
After discussion with the family he apparently had a cardiac
catheterization sometime in the last month at the [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 669**] VA
for unknown reasons. His wife reports that there were "some
plaques" but nothing to put stents in. Incidentally he was found
to have a pulmonary nodule and a CT was reccomended. He refused
at the time and was scheduled to have scan in one month.
.
In the ED he is intubated and sedated. Cooling procol was
initiated.
.
REVIEW OF SYSTEMS
Deferred as patient is intubated and sedated

Past Medical History:
Nonischemic cardiomyopathy with severely reduced lv systolic
function
HTN
Tobacco dependance
Nephrolithiasis
LBBB


Social History:
-Tobacco history: 50 Pack year history
-ETOH: Occasional
-Illicit drugs: Drugs


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.


Physical Exam:
Admission Exam

GENERAL: Intubated and sedated AAO X 0
HEENT: Large ecchymosis over left eye brow, some excoriations
over right cheek
NECK: In C collar
CARDIAC: S1 S2 No MRG
LUNGS: Audible inspiratory wheezes in bilateral apeices but
lodest over the RU lobe. Clear BS in the LLlobe
ABDOMEN: Soft cooling blanket in place so exam confounded.
EXTREMITIES: Cool 2+ pulses

Discharge Exam

General - room air; Vitals HR 70-89, BP 119-130/56-61, RR
18/min, O2 99% RA, Temp 97.7-98.1
HEENT: pupils equal; reactive to light
Neck: 3cm JVP
CV: H1 and H2 present; no murmurs
Resp: Lungs are clear to auscultation
GI: soft and nontender to palpation; bowels sounds presents
Extremities: peripheral pulses present; no ankle edema


Pertinent Results:
[**2168-7-7**] 03:15PM   WBC-17.8* RBC-4.95 HGB-15.1 HCT-44.0 MCV-89
MCH-30.6 MCHC-34.4 RDW-13.3
[**2168-7-7**] 03:15PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2168-7-7**] 03:33PM   GLUCOSE-138* LACTATE-1.5 NA+-135 K+-5.3*
CL--104 TCO2-25
[**2168-7-7**] 03:15PM   PT-30.1* PTT-47.0* INR(PT)-2.9*
[**2168-7-7**] 03:15PM   cTropnT-0.10*
[**2168-7-7**] 03:15PM   estGFR-Using this
[**2168-7-7**] 03:15PM   UREA N-10 CREAT-1.2

Discharge labs
[**2168-7-19**] 01:20PM BLOOD WBC-7.1 RBC-3.94* Hgb-11.7* Hct-35.8*
MCV-91 MCH-29.7 MCHC-32.7 RDW-14.3 Plt Ct-318
[**2168-7-19**] 01:20PM BLOOD Plt Ct-318
[**2168-7-19**] 01:20PM BLOOD PT-13.5* PTT-27.1 INR(PT)-1.3*
[**2168-7-19**] 01:20PM BLOOD Glucose-105* UreaN-6 Creat-1.3* Na-139
K-4.1 Cl-105 HCO3-25 AnGap-13
[**2168-7-13**] 05:07AM BLOOD ALT-29 AST-60* LD(LDH)-309* AlkPhos-49
TotBili-0.5

Brief Hospital Course:
68 year old man with idiopathic, non-ischemic dilated
cardiomyopathy s/p cardiac arrest and rewarming protocol
currently with newly discovered lung, liver and pancreatic
lesions concerning for malignancy.

# Pulmonary Nodule with perihilar lymphadenopathy:
The patient was found, incidentally to have a pulmonary nodule
with perihilar lymphadenopathy.  Given his long smoking history
there was a concern for malignancy.  After review of other
masses in abdomen, the lung nodule was deemed the best place for
initial biopsy.  U/S and MRI was performed to assess Liver and
pancreatic lesions and it was felt, with conjunction of IP and
IR that biopsing the lung would be the best route.  Patient went
for bronchial lung biopsy on [**7-18**] wihtout complications.  Results
are pending at time of discharge

# Liver, and pancreatic lesions: An ultrasound was showed at
least 5 lesions in the liver suggestive of hemangiomas. An
abdominal MRI revealed multiple liver masses believed to be
benign cysts and others that are hemangiomas. One liver mass was
believed to be potentially malignant. The pancreatic tail lesion
was believed to be potentially malignant. After lung biopsy and
pending results, it will need to be determined whether to biopsy
the pancreas since the tail of the pancreas is more likely to be
a primary than metastatic. He will follow up with outpatient
oncology at the VA for a body PET-CT, brain MRI, PFTs, and
spirometry with DLCO (this will be set up with the patient's
cardiologist, Dr. [**Last Name (STitle) 77893**].

# Chronic Systolic Heart Failure: The patient has non-ischemic
idiopathic dilated cardiomyopathy with EF 15%; it is still
unknown as to primary etiology.  Pt is on his home-dose
lisinopril 20mg and will leave on home dose Metoprolol Succinate
200mg daily.  The electrophysiology service was consulted
regarding possibly ICD vs. life vest placement given PEA vs.
Vtach arrest.  EP recommended Amiodarone over ICD or Life vest
as it has shown to be non-inferior to patients who are s/p
cardiac arrest in preventing further arrests. He will take
Amiodarone 200 mg [**Hospital1 **] for 1 month followed by 200 mg daily
indefinitely. This plan was discussed with the patient's
cardiologist, Dr. [**Last Name (STitle) 77893**], who agreed.

# Post-Obstructive Pneumonia: on Day 10 of
piperacillin-tazobactam and vancomycin.
Finished course [**7-18**].  Resolved upon discharge

# Afib:  Will continue beta-blockers.  Warfarin had been held
since early in the admission, first due to elevated INR and then
for upcoming procedures.  Will continue the patient's warfarin
at discharge, but at a lower dose as he was both
supratherapeutic coming into the hospital and discharged on
amiodarone. We have contact[**Name (NI) **] the patient's cardiologist, Dr.
[**Last Name (STitle) 77893**], regarding the need for close INR follow-up.

# Anemia: The patient's admission hematocrit was 44.0 and his
discharge hematocrit was 35.8. His nadir was 29.5 on [**2168-7-13**]. No
obvious cause of a normocytic anemia was found and the patient's
stool was guaiac negative.

# Hypertension: The patient's lisinopril and metoprolol were
continued throughout his hospital course to good effect.

Transitional issues:
# Outpatient oncologic workup: He will follow up with outpatient
oncology at the VA for a body PET-CT, brain MRI, PFTs, and
spirometry with DLCO (this will be set up with the patient's
cardiologist, Dr. [**Last Name (STitle) 77893**].

# Atrial fibrillation requiring anticoagulation: We have
contact[**Name (NI) **] the patient's cardiologist, Dr. [**Last Name (STitle) 77893**], regarding the
need for close INR follow-up.

# Anti-arrhythmic therapy: The patient will take Amiodarone 200
mg [**Hospital1 **] for 1 month followed by 200 mg daily indefinitely. This
plan was discussed with the patient's cardiologist, Dr. [**Last Name (STitle) 77893**],
who agreed.

# The patient was instructed not to return to work until he sees
his outpatient cardiologist. The patient understood the risks
and confirmed that he will not drive his truck.

Transitional issues: Follow up on anemia as his Hct dropped
during the hospital course but rebounded at discharge.
Recommend check CBC once to ensure it has normalized.

Medications on Admission:
MEDICATIONS:
Lisinopril 20mg QD
Metoprolol 200mg QD
Warfarin 2mg QD


Discharge Medications:
1. Amiodarone 200 mg PO BID
2. Lisinopril 20 mg PO DAILY
Start on [**7-16**] and continue daily
3. Metoprolol Succinate XL 200 mg PO DAILY
Start in AM of [**7-16**]. Home dose. Will d/c tartrate for tomorrow.
Hold for SBP < 100 or HR < 60
4. Warfarin 1 mg PO DAILY at 4pm
Please follow up closely with your doctor, [**First Name8 (NamePattern2) 2398**] [**Last Name (NamePattern1) 77893**], to
monitor your coumadin levels.


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Primary diagnoses:
-Chronic Cardiac systolic dysfunction after either pulseless
electrical activity orventricular tachycardia with arrest
-Lung, liver, and pancreatic masses

Secondary diagnoses:
-AFib
-HTN

Discharge Condition:
Fair.  Ambulatory.  Mental status intact.


Discharge Instructions:
Dr [**Last Name (STitle) **]. [**Known lastname 3952**],

You were admitted to the hospital because of cardiac arrest and
found to have lung, liver, and pancreatic masses.  You were
briefly intubated with a breathing tube, but successfuly taken
off in the intensive care unit.  The masses were better
characterized on MRI and it was felt that biopsy of the lung was
the best method for tissue diagnosis.  A biopsy was taken Monday
[**7-18**] by an interventional pulmonlogist.  Results are pending
and will be relayed to you after discharge.  You are leaving on
your same blood pressure medications that you came in with:
Metoprolol 200 mg daily and lisinopril 20 mg daily.  We have
also added a new medication called Amiodarone.  The dose will be
amiodarone 200 mg twice a day for one month, then 200 mg once a
day indefinitely.  You need to follow up with your cardiologist
at the VA Dr. [**Last Name (STitle) 112517**], regarding your coumadin dosing. Your
coumadin dose on discharge is 1mg, which is lower than when you
came in. Please continue 1mg until you see your cardiologist.

Followup Instructions:
Please make an appointment with your cardiologist, Dr. [**Last Name (STitle) 112517**],
by calling ([**Telephone/Fax (1) 112518**] and paging [**Numeric Identifier 112519**].


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**]
{'Paroxysmal ventricular tachycardia,Cardiogenic shock,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Other pneumothorax,Other primary cardiomyopathies,Precipitous drop in hematocrit,Acidosis,Personal history of sudden cardiac arrest,Other accidental fall from one level to another,Contusion of orbital tissues,Unspecified essential hypertension,Tobacco use disorder,Coronary atherosclerosis of native coronary artery,Neoplasm of uncertain behavior of trachea, bronchus, and lung,Other left bundle branch block,Calculus of kidney,Anticoagulants causing adverse effects in therapeutic use'}


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: S/P cardiac arrest

PRESENT ILLNESS: 68 YOM with unknonw PMH found at the back of loading truck for
unknown amount of time by friends. AED placed and shock
indicated. NO rhythm strip. Had agonal breaths. EMS Arrived. No
more shocks aDVISED. ems SAID "BIZZARE WIDE COMPLEX" and
tachycardic. Went to OSH ([**Hospital1 2436**]) intubated and coold.
Continued to have wide complex tachy. Got ami x2 with amio gtt.
Life flight arrived and he was in NSR with LBBB.
.
Patient was Kept on Amio Gtt when arrived. A CXR showed RUL
consolidation which was interpreted as possible pulmonary
contusion. There was a concern for aspiration and started on
Levo and flagyl.
.
After discussion with the family he apparently had a cardiac
catheterization sometime in the last month at the [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 669**] VA
for unknown reasons. His wife reports that there were "some
plaques" but nothing to put stents in. Incidentally he was found
to have a pulmonary nodule and a CT was reccomended. He refused
at the time and was scheduled to have scan in one month.
.
In the ED he is intubated and sedated. Cooling procol was
initiated.
.
REVIEW OF SYSTEMS
Deferred as patient is intubated and sedated

MEDICAL HISTORY: Nonischemic cardiomyopathy with severely reduced lv systolic
function
HTN
Tobacco dependance
Nephrolithiasis
LBBB

MEDICATION ON ADMISSION: MEDICATIONS:
Lisinopril 20mg QD
Metoprolol 200mg QD
Warfarin 2mg QD

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: 50 Pack year history
-ETOH: Occasional
-Illicit drugs: Drugs 

### Response:
{'Paroxysmal ventricular tachycardia,Cardiogenic shock,Pneumonia, organism unspecified,Pneumonitis due to inhalation of food or vomitus,Acute systolic heart failure,Other pneumothorax,Other primary cardiomyopathies,Precipitous drop in hematocrit,Acidosis,Personal history of sudden cardiac arrest,Other accidental fall from one level to another,Contusion of orbital tissues,Unspecified essential hypertension,Tobacco use disorder,Coronary atherosclerosis of native coronary artery,Neoplasm of uncertain behavior of trachea, bronchus, and lung,Other left bundle branch block,Calculus of kidney,Anticoagulants causing adverse effects in therapeutic use'}
