CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45-year-old man
who reports that he had had progressive shortness of breath
and occasional chest pain for the past several years,
especially with exertion.  The patient was admitted in
[**Month (only) 404**] of last year, ruled out for myocardial infarction but
was diagnosed with hypertrophic obstructive cardiomyopathy
after transesophageal echocardiogram showed dynamic outflow
obstruction with a peak gradient of 32.  A subsequent
catheter showed a systolic gradient of 130 after PVC and 96
after Valsalva.  Trial of medical management failed to
relieve the patient's symptoms, as did a prior alcohol septal
ablation in [**2156-12-11**].  Therefore, the patient was
brought to catheter lab on the day of admission for a second
more aggressive alcohol ablation.  In the catheter lab here,
the patient's systolic gradient was noted to be absent,
however it was seen to rise to 100 mmHg with dobutamine
stress.  The initial septal artery was noted to be absent and
the second septal artery which had two branches, both of
which were injected with ethanol and that resulted in the
complete resolution of the gradient even with dobutamine
stress in the lab.  The patient was brought to the Coronary
Critical Care Unit with 6/10 chest pain, however he had no
shortness of breath, diaphoresis, nausea or vomiting when he
arrived on the unit.

MEDICAL HISTORY: 1.  Hypertrophic cardiomyopathy
2.  Hypercholesterolemia

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: VITAL SIGNS:  Temperature 96.3??????, pulse 72, blood pressure
125/78, respiratory rate 16.  Patient was saturating 98% on
room air.
GENERAL:  He is alert and oriented x3 in no acute distress,
obese middle aged man.
HEAD, EARS, EYES, NOSE AND THROAT:  Pupils were equal, round
and reactive to light.  Mucous membranes were moist.  His
oropharynx was clear.
NECK:  He had no jugular venous distention, elevation while
lying flat.  The patient had no thyromegaly.  The patient had
no lymphadenopathy.
CARDIOVASCULAR:  He had a regular rate, normal S1, normal S2
and no murmurs when he presented to the unit.
LUNGS:  Clear to auscultation bilaterally.  No wheezes.
EXTREMITIES:  He had 2+ dorsalis pedis and posterior tibialis
pulses bilaterally.  No thrill, hematoma or bruit over either
catheter site.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other primary cardiomyopathies,Alcohol withdrawal,Right bundle branch block,Other and unspecified hyperlipidemia,Examination of participant in clinical trial
Prim cardiomyopathy NEC,Alcohol withdrawal,Rt bundle branch block,Hyperlipidemia NEC/NOS,Exam-clincal trial
Admission Date:  [**2157-7-15**]       Discharge Date:  [**2157-7-18**]

Date of Birth:   [**2111-12-11**]       Sex:  M

Service:  CORONARY CRITICAL CARE

HISTORY OF PRESENT ILLNESS:  The patient is a 45-year-old man
who reports that he had had progressive shortness of breath
and occasional chest pain for the past several years,
especially with exertion.  The patient was admitted in
[**Month (only) 404**] of last year, ruled out for myocardial infarction but
was diagnosed with hypertrophic obstructive cardiomyopathy
after transesophageal echocardiogram showed dynamic outflow
obstruction with a peak gradient of 32.  A subsequent
catheter showed a systolic gradient of 130 after PVC and 96
after Valsalva.  Trial of medical management failed to
relieve the patient's symptoms, as did a prior alcohol septal
ablation in [**2156-12-11**].  Therefore, the patient was
brought to catheter lab on the day of admission for a second
more aggressive alcohol ablation.  In the catheter lab here,
the patient's systolic gradient was noted to be absent,
however it was seen to rise to 100 mmHg with dobutamine
stress.  The initial septal artery was noted to be absent and
the second septal artery which had two branches, both of
which were injected with ethanol and that resulted in the
complete resolution of the gradient even with dobutamine
stress in the lab.  The patient was brought to the Coronary
Critical Care Unit with 6/10 chest pain, however he had no
shortness of breath, diaphoresis, nausea or vomiting when he
arrived on the unit.

PAST MEDICAL HISTORY:
1.  Hypertrophic cardiomyopathy
2.  Hypercholesterolemia

MEDICATIONS PRIOR TO ARRIVING HERE:
1.  Aspirin 325 mg q day
2.  Verapamil 180 mg q day
3.  Metoprolol 50 mg q day

PHYSICAL EXAM:
VITAL SIGNS:  Temperature 96.3??????, pulse 72, blood pressure
125/78, respiratory rate 16.  Patient was saturating 98% on
room air.
GENERAL:  He is alert and oriented x3 in no acute distress,
obese middle aged man.
HEAD, EARS, EYES, NOSE AND THROAT:  Pupils were equal, round
and reactive to light.  Mucous membranes were moist.  His
oropharynx was clear.
NECK:  He had no jugular venous distention, elevation while
lying flat.  The patient had no thyromegaly.  The patient had
no lymphadenopathy.
CARDIOVASCULAR:  He had a regular rate, normal S1, normal S2
and no murmurs when he presented to the unit.
LUNGS:  Clear to auscultation bilaterally.  No wheezes.
EXTREMITIES:  He had 2+ dorsalis pedis and posterior tibialis
pulses bilaterally.  No thrill, hematoma or bruit over either
catheter site.

LABS UPON ADMISSION:  Chem-7:  Sodium 141, potassium 4.1,
chloride 104, bicarbonate 25, BUN 18, creatinine 0.8, glucose
101.  His CK was 1237.  CK/MB was 175.  His index was 14.1.
His white blood cell count was 12.1, hemoglobin 14.4,
hematocrit 39.9, platelets 289.  His second CK was 1874 with
a CK/MB of 281 and index of 15.  His third CK on [**7-16**],
the second day of admission, was 1,119 with a CK/MB of 59 and
an index of 5.3.  Fasting lipid profile was drawn on [**7-16**]
which showed a triglyceride level of 178, HDL 41 and an LDL
of 137 with a cholesterol to HDL index of 5.2.

HOSPITAL COURSE:

1.  CARDIOVASCULAR:  A.  Coronary artery disease:  The
patient had no known coronary artery disease, however he
demonstrated increased LDL on the fasting lipid profile and
has a history of hyperlipidemia.  The patient should be
keeping his LDL under 100 in light of his compromised
cardiovascular situation.  The patient was started on 20 mg q
day of Lipitor for his hyperlipidemia.  The patient was
continued on his once a day aspirin regimen.  B.  Pump:  The
patient's outflow gradient seemed to be decreased based on an
echocardiogram done in the catheter lab, but it was not clear
if the patient will have clinical improvement.  The patient
had a quick CK washout as expected and peaked adequately
indicating good septal ablation.  Serial electrocardiograms
showed evidence of a right bundle branch block that was
consistent with his prior electrocardiogram, but no other
evidence of AV conduction block.  The patient was sent home
with 100 q day of atenolol and 240 mg q day of Verapamil.  C.
Rhythm:  The patient was placed on a prophylactic transvenous
pacer due to the high risk of complete heart block with
septal ablation.  He was conducting on his own throughout his
hospitalization and his pacer was not needed to capture
beats.  The transvenous pacer was removed on the day prior to
discharge.  The patient had no evidence of heart block
throughout the hospitalization.

2.  PULMONARY:  The patient saturated well on room air
throughout his hospitalization.

3.  RENAL:  Serial chem-7 showed no adverse effect from the
large dye load the patient received in the catheter lab.

4.  FLUIDS, ELECTROLYTES AND NUTRITION/GASTROINTESTINAL:  No
issues.

5.  INFECTIOUS DISEASE:  The patient spiked a temperature to
104?????? on hospital day #2.  Pan cultures were negative at the
time of discharge with no growth to date.  Chest x-ray was
normal.  The patient was thought to have spiked a fever as
the result of possibly atelectasis or potentially as a
symptom of alcohol withdrawal for which he was given Ativan
x1, however the patient had no other symptoms of alcohol
withdrawal, as he is a binge drinker reporting 12 drinks per
week all on the same occasion.  The patient was monitored per
the CIWA protocol and the only evidence of withdrawal was the
fever.  Low index is suspicion for alcohol withdrawal for his
hospitalization.

6.  PROPHYLAXIS:  The patient was given Protonix throughout
his hospitalization and docusate throughout his
hospitalization.

DISPOSITION:  The patient was discharged to home.

DISCHARGE CONDITION:  Good

DISCHARGE DIAGNOSES:
1.  Hypertrophic obstructive cardiomyopathy, status post
septal ablation
2.  Hyperlipidemia
3.  Right bundle branch block
4.  Alcohol withdrawal





                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D.  [**MD Number(1) 5211**]

Dictated By:[**Last Name (NamePattern1) 11117**]
MEDQUIST36

D:  [**2157-7-18**]  11:54
T:  [**2157-7-18**]  12:15
JOB#:  [**Job Number 36367**]

cc: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 36368**] AT [**PO Box 36369**] BUCKSPORT, [**Numeric Identifier 36370**]
    [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **] AT ONE EVERGREEN [**Doctor Last Name **], [**Street Address(2) 36371**], [**Location (un) 36372**], [**Numeric Identifier 36373**]
    [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15176**], M.D., [**Location (un) **], [**Location (un) **], [**Numeric Identifier 36374**]
{'Other primary cardiomyopathies,Alcohol withdrawal,Right bundle branch block,Other and unspecified hyperlipidemia,Examination of participant in clinical trial'}


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 45-year-old man
who reports that he had had progressive shortness of breath
and occasional chest pain for the past several years,
especially with exertion.  The patient was admitted in
[**Month (only) 404**] of last year, ruled out for myocardial infarction but
was diagnosed with hypertrophic obstructive cardiomyopathy
after transesophageal echocardiogram showed dynamic outflow
obstruction with a peak gradient of 32.  A subsequent
catheter showed a systolic gradient of 130 after PVC and 96
after Valsalva.  Trial of medical management failed to
relieve the patient's symptoms, as did a prior alcohol septal
ablation in [**2156-12-11**].  Therefore, the patient was
brought to catheter lab on the day of admission for a second
more aggressive alcohol ablation.  In the catheter lab here,
the patient's systolic gradient was noted to be absent,
however it was seen to rise to 100 mmHg with dobutamine
stress.  The initial septal artery was noted to be absent and
the second septal artery which had two branches, both of
which were injected with ethanol and that resulted in the
complete resolution of the gradient even with dobutamine
stress in the lab.  The patient was brought to the Coronary
Critical Care Unit with 6/10 chest pain, however he had no
shortness of breath, diaphoresis, nausea or vomiting when he
arrived on the unit.

MEDICAL HISTORY: 1.  Hypertrophic cardiomyopathy
2.  Hypercholesterolemia

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: VITAL SIGNS:  Temperature 96.3??????, pulse 72, blood pressure
125/78, respiratory rate 16.  Patient was saturating 98% on
room air.
GENERAL:  He is alert and oriented x3 in no acute distress,
obese middle aged man.
HEAD, EARS, EYES, NOSE AND THROAT:  Pupils were equal, round
and reactive to light.  Mucous membranes were moist.  His
oropharynx was clear.
NECK:  He had no jugular venous distention, elevation while
lying flat.  The patient had no thyromegaly.  The patient had
no lymphadenopathy.
CARDIOVASCULAR:  He had a regular rate, normal S1, normal S2
and no murmurs when he presented to the unit.
LUNGS:  Clear to auscultation bilaterally.  No wheezes.
EXTREMITIES:  He had 2+ dorsalis pedis and posterior tibialis
pulses bilaterally.  No thrill, hematoma or bruit over either
catheter site.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other primary cardiomyopathies,Alcohol withdrawal,Right bundle branch block,Other and unspecified hyperlipidemia,Examination of participant in clinical trial'}
