CHIEF COMPLAINT: dizziness, lightheadedness

PRESENT ILLNESS: 67 yo male, h/o CAD s/p CABG in [**2173**] (LIMA to LAD, SVG to OM,
SVG to PDA), HTN, DM, Hyperlipidemia, presenting iwth chest
pain, transferred for cathterization.  He presented to the ED in
[**Location (un) **] with complaints of dizziness.  He states that he had [**3-6**]
episodes of dizziness in the past few weeks; the first occurred
while driving.  He reports feelings of dizziness and
palpitations accompanied by lightheadedness and diaphoresis.  He
denied CP/SOB/syncope.  This recurred on night prior to
admission and was accompanied by a brief episode of syncope
(lasting seconds; denies seizure activity, post ictal confusion,
no loss of bowel or bladder function).  This is different from
angina he has had in the past (describes occasional chest pain
relieved by nitro s/p cabg).  He went to the ED where tnt was
reportedly 0.47 and EKG showed "inferolateral" changes by
report.  He was given 600 mg Plavix, lovenox 80 mg, 5 mg IV
lopressor, ASA, and NTG.  He was transferred to [**Hospital1 18**] to
cathterization lab where stent was placed to one of his SVG
grafts (by verbal report; written report not yet available)
.
Upon arrival to the floor, he was nauseous (had been given
versed, anzemet, and atropine in lab for this) and had some
oozing from his left groin.  He stated he still felt nauseous
and dizzy but denied CP/SOB.

MEDICAL HISTORY: PMH:
1.  CAD, s/p CABG in [**2173**] with LIMA to LAD, SVG to OM, SVG to
PDA
2.  CHF, EF=40%
3.  DM 2
4.  HTN
5.  Hypercholesterolemia
6.  GERD
7.  s/p appy, with hernia at incisional site
8.  DVT in [**2160**] as complication of catheterization, s/p vascular
procedure for this as per his report

MEDICATION ON ADMISSION: Meds on admission:
Metoprolol 50 mg [**Hospital1 **]
Metformin 1000 mg [**Hospital1 **]
Allopurinol 150 mg
Zantac 150 mg [**Hospital1 **]
Glyburide 5 mg [**Hospital1 **]
Lisinopril 10 mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
VS: 96.3   158/73   63  20  96% 2L NC  FS=172
Gen: mild distress, pleasant male, sleepy, A&Ox3
HEENT: PERRL, OP clear
Neck: no JVD appreciated, no bruits
Lungs: CTA bilat from anterior exam
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd; with surgical scar in RLQ, small reducible
hernia involving umbilicus
Extr: trace edema bilaterally; 2+ DP/PT pulses bilaterally and
sensation intact to light touch
Groin: left groin with sheath in place, mild ooze and tenderness
to palpation

FAMILY HISTORY: no early CAD

SOCIAL HISTORY: Lives with girlfriend; smokes [**4-4**] ppd x 50+ years
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia
Subendo infarct, initial,Acute kidney failure NOS,Parox ventric tachycard,Urin tract infection NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2178-9-1**]              Discharge Date:   [**2178-9-5**]

Date of Birth:  [**2111-6-3**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 1171**]
Chief Complaint:
dizziness, lightheadedness

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
67 yo male, h/o CAD s/p CABG in [**2173**] (LIMA to LAD, SVG to OM,
SVG to PDA), HTN, DM, Hyperlipidemia, presenting iwth chest
pain, transferred for cathterization.  He presented to the ED in
[**Location (un) **] with complaints of dizziness.  He states that he had [**3-6**]
episodes of dizziness in the past few weeks; the first occurred
while driving.  He reports feelings of dizziness and
palpitations accompanied by lightheadedness and diaphoresis.  He
denied CP/SOB/syncope.  This recurred on night prior to
admission and was accompanied by a brief episode of syncope
(lasting seconds; denies seizure activity, post ictal confusion,
no loss of bowel or bladder function).  This is different from
angina he has had in the past (describes occasional chest pain
relieved by nitro s/p cabg).  He went to the ED where tnt was
reportedly 0.47 and EKG showed "inferolateral" changes by
report.  He was given 600 mg Plavix, lovenox 80 mg, 5 mg IV
lopressor, ASA, and NTG.  He was transferred to [**Hospital1 18**] to
cathterization lab where stent was placed to one of his SVG
grafts (by verbal report; written report not yet available)
.
Upon arrival to the floor, he was nauseous (had been given
versed, anzemet, and atropine in lab for this) and had some
oozing from his left groin.  He stated he still felt nauseous
and dizzy but denied CP/SOB.


Past Medical History:
PMH:
1.  CAD, s/p CABG in [**2173**] with LIMA to LAD, SVG to OM, SVG to
PDA
2.  CHF, EF=40%
3.  DM 2
4.  HTN
5.  Hypercholesterolemia
6.  GERD
7.  s/p appy, with hernia at incisional site
8.  DVT in [**2160**] as complication of catheterization, s/p vascular
procedure for this as per his report


Social History:
Lives with girlfriend; smokes [**4-4**] ppd x 50+ years

no early CAD


Family History:
no early CAD

Physical Exam:
PE:
VS: 96.3   158/73   63  20  96% 2L NC  FS=172
Gen: mild distress, pleasant male, sleepy, A&Ox3
HEENT: PERRL, OP clear
Neck: no JVD appreciated, no bruits
Lungs: CTA bilat from anterior exam
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd; with surgical scar in RLQ, small reducible
hernia involving umbilicus
Extr: trace edema bilaterally; 2+ DP/PT pulses bilaterally and
sensation intact to light touch
Groin: left groin with sheath in place, mild ooze and tenderness
to palpation


Pertinent Results:
EKG: NSR 65, with IVCD/incomplete left bundle, left axis; TWI in
II, III; q's in III, F

[**2178-9-1**] 11:40PM   POTASSIUM-4.6
[**2178-9-1**] 11:40PM   CK(CPK)-38
[**2178-9-1**] 11:40PM   PLT COUNT-228
[**2178-9-1**] 07:14PM   POTASSIUM-4.1
[**2178-9-1**] 07:14PM   WBC-10.3 RBC-4.97# HGB-13.5*# HCT-38.7*#
MCV-78* MCH-27.1 MCHC-34.8 RDW-15.9*
[**2178-9-1**] 05:36PM   GLUCOSE-143*

Cardiac Catheterization:  DES placed to SVG to PDA; LIMA to LAD
and SVG to OM patent

Brief Hospital Course:
1.  CAD: s/p CABG in [**2173**], now with chest pain, EKG changes, and
positive cardiac enzymes.  Catheterization was performed, and
DES was placed in SVG-PDA graft.  He remained chest pain free,
and EKG was without changes.  CE's trended down and remained
normal.  He was maintained on ASA, Plavix, Lopressor,
Lisinopril.  He was started on Lipitor, but patient stated he
does not wish to take this and will discuss with his
cardiologist.  He had a large groin hematoma with superficial
bruising.  This resolved, and he never had bruit or signs of
neurovascular compromise.  Hematocrit remained stable.  He was
discharged, to follow up with his cardiologist.

2. WCT: patient developed witnessed WCT on his second hospital
stay post cath,  his SBP was in the 170s and good mentation at
the time of the WCT.  He felt slight dizzy at the time of WCt,
but denied any chest pressure, SOB, or palpitation.  He was
given lidocaine bolus and spontaneously converted back to sinus
rhthym.  He was started on lidocaine drip and transferred to the
CCU for further management.  EP recommended discontinuing
lidocaine drip and starting sotalol PO intially 80mg PO bid,
which was increased to 120mg PO bid.  He was scheduled for an
echo to evaluate
LV function which showed an estimated EF of 40%, with focal wall
motion abnormalities.  ICD/pacemaker (atrial sensed/paced) was
placed on [**2178-9-3**], and he had no further episodes of ventricular
tachycardia.  He will follow up in Device clinic in 1 week for
check.  He was discharged on the sotalol and metoprolol.

3. CHF: TTE was checked; EF was 40% with multiple wall motion
abnormalities (no apical akinesis).  ACEI was continued, and he
remained euvolemic.

4.  Nausea/vomiting: s/p cath, may be vagal component (s/p
atropine in cath lab). He was given antiemetics as needed, and
this resolved.

5.  DM: on glyburide and metformin as [**Last Name (LF) 3782**], [**First Name3 (LF) **] cover with SSI
in-house.  Oral hypoglycemics were restarted at time of
discharge.

6.  CRF: Creatinine remained stable (baseline 1.5-1.6).  He
received fluids with HCO3- after catheterization/dye load.

7.  HTN: nitro gtt was continued after cath lab until SBP
normalized.  He was continued on BB and ACEI in-house.

8.  UTI: He was found to have a UTI (leukocytosis, positive UA),
and he was started on ciprofloxacin x 7 days.

9.  Disposition: He was discharged in good condition, to follow
up in device clinic and with he cardiologist.

Medications on Admission:
Meds on admission:
Metoprolol 50 mg [**Hospital1 **]
Metformin 1000 mg [**Hospital1 **]
Allopurinol 150 mg
Zantac 150 mg [**Hospital1 **]
Glyburide 5 mg [**Hospital1 **]
Lisinopril 10 mg qd

ALL: NKDA


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
pci.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*11*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for pci.
Disp:*30 Tablet(s)* Refills:*11*
3. Allopurinol 100 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).

4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Sotalol 80 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day).
Disp:*90 Tablet(s)* Refills:*2*
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Zantac 150 mg Capsule Sig: One (1) Capsule PO twice a day.
8. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.

9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO twice a day.
10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 6 days.
Disp:*12 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
Primary Diagnoses:
1.  CAD, s/p catheterization and stenting
2.  Ventricular Tachycardia, s/p placement of ICD
3.  Hypertension
Secondary Diagnoses:
1.  Diabetes Mellitus, type 2
2.  Hyperlipidemia
3.  Renal insufficiency
4.  Urinary tract infection

Discharge Condition:
Good

Discharge Instructions:
1.  Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1500 cc daily

2.  Please follow up with your cardiologist as described below.

3.  Please take all your medications exactly as prescribed and
described in this discharge paperwork.  We made the following
changes:
- ASA 325 mg daily and Plavix 75 mg daily for at least 1 year.
It is extremely important that you take these medications every
day, without missing a single dose.  They will help prevent your
new stent from clotting.
- Sotalol 80 mg twice daily
- We added Lipitor 80 mg daily.
- We added Ciprofloxacin 500 mg twice daily for 6 more days for
your urinary tract infection.

4.  Please call your doctor if you are experiencing chest pain,
shortness of breath, fever, chills, palpitations,
lightheadedness, dizziness, or any other concerning symptoms.

Followup Instructions:
1.  Follow up with Dr. [**Last Name (STitle) 11493**] ([**Telephone/Fax (1) 29810**]) within 1-2 weeks of
discharge

2.  Follow up with EP as instructed at time of discharge.
Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2178-9-8**]
9:00
You must keep the dressing over your ICD clean and dry until you
follow up in clinic.

3.  You should avoid heavy lifting or physical exertion for at
least 2-3 weeks.  Adhere to driving restrictions outlined.

4.  You will need monitoring of your liver function given
lipitor therapy.  This should be done at least every 6 months.
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: dizziness, lightheadedness

PRESENT ILLNESS: 67 yo male, h/o CAD s/p CABG in [**2173**] (LIMA to LAD, SVG to OM,
SVG to PDA), HTN, DM, Hyperlipidemia, presenting iwth chest
pain, transferred for cathterization.  He presented to the ED in
[**Location (un) **] with complaints of dizziness.  He states that he had [**3-6**]
episodes of dizziness in the past few weeks; the first occurred
while driving.  He reports feelings of dizziness and
palpitations accompanied by lightheadedness and diaphoresis.  He
denied CP/SOB/syncope.  This recurred on night prior to
admission and was accompanied by a brief episode of syncope
(lasting seconds; denies seizure activity, post ictal confusion,
no loss of bowel or bladder function).  This is different from
angina he has had in the past (describes occasional chest pain
relieved by nitro s/p cabg).  He went to the ED where tnt was
reportedly 0.47 and EKG showed "inferolateral" changes by
report.  He was given 600 mg Plavix, lovenox 80 mg, 5 mg IV
lopressor, ASA, and NTG.  He was transferred to [**Hospital1 18**] to
cathterization lab where stent was placed to one of his SVG
grafts (by verbal report; written report not yet available)
.
Upon arrival to the floor, he was nauseous (had been given
versed, anzemet, and atropine in lab for this) and had some
oozing from his left groin.  He stated he still felt nauseous
and dizzy but denied CP/SOB.

MEDICAL HISTORY: PMH:
1.  CAD, s/p CABG in [**2173**] with LIMA to LAD, SVG to OM, SVG to
PDA
2.  CHF, EF=40%
3.  DM 2
4.  HTN
5.  Hypercholesterolemia
6.  GERD
7.  s/p appy, with hernia at incisional site
8.  DVT in [**2160**] as complication of catheterization, s/p vascular
procedure for this as per his report

MEDICATION ON ADMISSION: Meds on admission:
Metoprolol 50 mg [**Hospital1 **]
Metformin 1000 mg [**Hospital1 **]
Allopurinol 150 mg
Zantac 150 mg [**Hospital1 **]
Glyburide 5 mg [**Hospital1 **]
Lisinopril 10 mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
VS: 96.3   158/73   63  20  96% 2L NC  FS=172
Gen: mild distress, pleasant male, sleepy, A&Ox3
HEENT: PERRL, OP clear
Neck: no JVD appreciated, no bruits
Lungs: CTA bilat from anterior exam
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd; with surgical scar in RLQ, small reducible
hernia involving umbilicus
Extr: trace edema bilaterally; 2+ DP/PT pulses bilaterally and
sensation intact to light touch
Groin: left groin with sheath in place, mild ooze and tenderness
to palpation

FAMILY HISTORY: no early CAD

SOCIAL HISTORY: Lives with girlfriend; smokes [**4-4**] ppd x 50+ years 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia'}
