CHIEF COMPLAINT: VT storm

PRESENT ILLNESS: Pt is a 74-year-old male with a history of idiopathic dilated
cardiomyopathy s/p CRT/D (ICD), VT on amioderone, admitted to
OSH with [**Hospital **] transfered to [**Hospital1 18**] for possible VT ablation.
Patient is poor historian, and information taken from transfer
paperwork. Patient began to experience ICD firing 2 months prior
to presentation. At that time, he was advised to take
amioderone/mexiletine, but patient declined mexiletine due to
concern of polypharmacy. On [**12-24**], patient's ICD again fired,
and was admitted to [**Hospital 27292**] hospital. It appears that patient
was asymptomatic to VT, and only felt a premonatory fluttering
before shock. He denies any chest pain, SOB, lightheadedness, or
syncope. While admitted, patient had recurrent VT, and was
transfered to [**Hospital 33663**] Hospital for VT ablation on [**12-31**]. During
that hospitalization, he was on azithro/zosyn, but does not
appear patient had any clear infection.
.
At [**Location (un) 33663**], despite being managed on amioderone/lidocaine,
patient had recurrent VT, which was reportedly broken with both
ATP pacing and ICD firing. Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 81446**] attempted a VT
ablation. The patient became hypotensive and hypoxic during the
procedure, and case was aborted. The patient was continued on
amiodarone/lidocaine, and intially transitioned to mexiletine,
but with recurrent VT, lidocaine was re-intiated. Patient
transfered to [**Hospital1 18**] for further manegement.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, cough, hemoptysis, black stools or
red stools. He denies recent fevers, chills or rigors. He denies
exertional buttock or calf pain. The patient says he has been
experiencing a productive cough. All of the other review of
systems were negative.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: Dyslipidemia
2. CARDIAC HISTORY:
-PACING/ICD: BiV-ICD
3. OTHER PAST MEDICAL HISTORY:
.
Idiopathic CM with NYHF III
Mod-Sev MR
Mild AS
VT on amioderone
B/L Knee OA s/p R Knee replacement [**2169**]
Gout
Unclear why on coumadin

MEDICATION ON ADMISSION: Home Medications:
Lipitor 40mg daily
Lorazepam 0.25mg PRN
Spironolactone 50mg daily
Lasix 60mg qam; 20mg qPM
Amiodarone 200mg daily
Digoxin 0.125mg daily
Cozaar 25mg daily
Coreg 3.125 [**Hospital1 **]
Coumadin
Allopurinol
.
Medications at Transfer:
Spironolactone 50mg daily
Lasix 20mg qpm
Lasix 60mg qam
Carvedilol 3.125mg [**Hospital1 **]
Lipitor 40mg daily
Losartan 25mg daily
Allopurinol 100mg [**Hospital1 **]
Lidocaine gtt
Baclofen 10mg q8 PRN
Alprazolam 0.25mg q12 PRN
Amiodarone ggt

ALLERGIES: Codeine / Demerol / Heparin Agents

PHYSICAL EXAM: VS: T=98 BP=114/63 HR=92 RR=14
GENERAL: Diaphoretic male, appears uncomfortable, moaning in
pain. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Right pupil RRL, Anasacoria of
left pupil EOMI. Conjunctiva were pink, no pallor or cyanosis of
the oral mucosa. No xanthalesma.
NECK: Supple with JVP of 8 cm.
CARDIAC: PMI laterally displaced RR, normal S1, ? paradoxically
spit s2, + s4, [**2-15**] early intiated blowing murmur loudest at
apex. No thrills, lifts.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Trace UE edema, no pre-tibial edema
SKIN: ? infected papule in LUE, LLE slightly cool
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 1+ DP diminished
Left: Carotid 2+ Femoral 2+ Popliteal 1+ DP diminished

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: No Quit smoking:
-ETOH: Denies
-Illicit drugs: No
Paroxysmal ventricular tachycardia,Pneumonia, organism unspecified,Other primary cardiomyopathies,Chronic systolic heart failure,Acute kidney failure, unspecified,Cardiogenic shock,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Heparin-induced thrombocytopenia (HIT),Automatic implantable cardiac defibrillator in situ
Parox ventric tachycard,Pneumonia, organism NOS,Prim cardiomyopathy NEC,Chr systolic hrt failure,Acute kidney failure NOS,Cardiogenic shock,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Heparin-indu thrombocyto,Status autm crd dfbrltr
Admission Date:  [**2171-1-2**]              Discharge Date:   [**2171-1-18**]

Date of Birth:  [**2096-10-12**]             Sex:   M

Service: MEDICINE

Allergies:
Codeine / Demerol / Heparin Agents

Attending:[**First Name3 (LF) 4765**]
Chief Complaint:
VT storm

Major Surgical or Invasive Procedure:
VT ablation
Endotracheal intubation and mechanical ventilation

History of Present Illness:
Pt is a 74-year-old male with a history of idiopathic dilated
cardiomyopathy s/p CRT/D (ICD), VT on amioderone, admitted to
OSH with [**Hospital **] transfered to [**Hospital1 18**] for possible VT ablation.
Patient is poor historian, and information taken from transfer
paperwork. Patient began to experience ICD firing 2 months prior
to presentation. At that time, he was advised to take
amioderone/mexiletine, but patient declined mexiletine due to
concern of polypharmacy. On [**12-24**], patient's ICD again fired,
and was admitted to [**Hospital 27292**] hospital. It appears that patient
was asymptomatic to VT, and only felt a premonatory fluttering
before shock. He denies any chest pain, SOB, lightheadedness, or
syncope. While admitted, patient had recurrent VT, and was
transfered to [**Hospital 33663**] Hospital for VT ablation on [**12-31**]. During
that hospitalization, he was on azithro/zosyn, but does not
appear patient had any clear infection.
.
At [**Location (un) 33663**], despite being managed on amioderone/lidocaine,
patient had recurrent VT, which was reportedly broken with both
ATP pacing and ICD firing. Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 81446**] attempted a VT
ablation. The patient became hypotensive and hypoxic during the
procedure, and case was aborted. The patient was continued on
amiodarone/lidocaine, and intially transitioned to mexiletine,
but with recurrent VT, lidocaine was re-intiated. Patient
transfered to [**Hospital1 18**] for further manegement.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, cough, hemoptysis, black stools or
red stools. He denies recent fevers, chills or rigors. He denies
exertional buttock or calf pain. The patient says he has been
experiencing a productive cough. All of the other review of
systems were negative.

Past Medical History:
1. CARDIAC RISK FACTORS:: Dyslipidemia
2. CARDIAC HISTORY:
-PACING/ICD: BiV-ICD
3. OTHER PAST MEDICAL HISTORY:
.
Idiopathic CM with NYHF III
Mod-Sev MR
Mild AS
VT on amioderone
B/L Knee OA s/p R Knee replacement [**2169**]
Gout
Unclear why on coumadin


Social History:
-Tobacco history: No Quit smoking:
-ETOH: Denies
-Illicit drugs: No


Family History:
No family history of early MI, otherwise non-contributory.

Physical Exam:
VS: T=98 BP=114/63 HR=92 RR=14
GENERAL: Diaphoretic male, appears uncomfortable, moaning in
pain. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Right pupil RRL, Anasacoria of
left pupil EOMI. Conjunctiva were pink, no pallor or cyanosis of
the oral mucosa. No xanthalesma.
NECK: Supple with JVP of 8 cm.
CARDIAC: PMI laterally displaced RR, normal S1, ? paradoxically
spit s2, + s4, [**2-15**] early intiated blowing murmur loudest at
apex. No thrills, lifts.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Trace UE edema, no pre-tibial edema
SKIN: ? infected papule in LUE, LLE slightly cool
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 1+ DP diminished
Left: Carotid 2+ Femoral 2+ Popliteal 1+ DP diminished


Pertinent Results:
LABS ON ADMISSION:
.
HEMATOLOGY:
[**2171-1-2**] 10:22PM BLOOD WBC-16.0* RBC-4.49* Hgb-13.2* Hct-38.9*
MCV-87 MCH-29.5 MCHC-34.0 RDW-15.4 Plt Ct-361
[**2171-1-2**] 10:22PM BLOOD Neuts-90.1* Lymphs-6.3* Monos-2.8 Eos-0.6
Baso-0.2
[**2171-1-2**] 10:22PM BLOOD PT-15.2* PTT-23.5 INR(PT)-1.3*
.
CHEMISTRY:
[**2171-1-2**] 10:22PM BLOOD Glucose-103 UreaN-33* Creat-1.2 Na-135
K-4.6 Cl-98 HCO3-27 AnGap-15
[**2171-1-2**] 10:22PM BLOOD ALT-36 AST-51* LD(LDH)-479* AlkPhos-82
TotBili-0.9
[**2171-1-2**] 10:22PM BLOOD Albumin-3.1* Calcium-8.6 Phos-3.4 Mg-2.2
[**2171-1-2**] 10:22PM BLOOD TSH-2.2
[**2171-1-4**] 01:36PM BLOOD Type-ART pO2-186* pCO2-33* pH-7.48*
calTCO2-25 Base XS-2
[**2171-1-3**] 06:11AM BLOOD Lactate-1.5
.
MICROBIOLOGY:
Bl Cx - negative
Urine Cx - negative
Sputum - yeast, oropharyngeal flora
.
CARDIOLOGY:
.
EKG [**1-3**]: Atrial sensed, ventricular paced rhythm. No previous
tracing available for comparison.
.
ECHO [**1-4**]: The left atrium is mildly dilated. Left ventricular
wall thicknesses are normal. The left ventricular cavity is
severely dilated. There is an inferobasal left ventricular
aneurysm. There is severe regional left ventricular systolic
dysfunction with akinesis of the inferior, inferolateral and
lateral walls, as well as the distal [**1-12**] of the ventricle.
Anterior and septal wall function is relatively preserved,
though not normal (LVEF = 20-25%). The right ventricular cavity
is mildly dilated with severe focal hypokinesis of the apical
free wall, and milder hypokinesis of the rest of the free wall.
The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. Mild to moderate ([**1-11**]+) aortic
regurgitation is seen. Mitral valve leaflets are mildly
thickened. There is bileaflet systolic tenting, secondary to LV
dilatation and chordal tension. There is no mitral valve
prolapse. A slightly eccentric, posteriorly-directed jet of
moderate to severe (3+) mitral regurgitation is seen. There is
severe pulmonary artery systolic hypertension. There is no
pericardial effusion.

IMPRESSION: Dilated left ventricle with an inferobasal LV
aneurysm and severe regional systolic dysfunction. Regional
right ventricular dysfunction. Mild to moderate aortic
regurgitation. Moderate to severe mitral regurgitation. Severe
pulmonary hypertension.

Findings are overall most consistent with a prior extensive
inferoposterior and right ventricular myocardial infarction
followed by adverse LV remodeling.
.
.
RADIOLOGY:
.
[**1-3**] CXR: Single portable radiograph of the chest demonstrates
no interval change in the right internal jugular central venous
catheter, seen on the chest radiograph obtained nine hours
prior. No pneumothorax. Cardiomediastinal contours are
unchanged. There is megaly. There are small bilateral pleural
effusions and mild bibasilar atelectasis. Increased airspace
opacity involving both lungs persists, although somewhat less
conspicuous than seen previously. Increased airspace opacity
involving the left lower lung corresponds to the retrocardiac
opacity seen on the previous study. The trachea is midline. No
pneumothorax.
IMPRESSION:
Persistent mild CHF and retrocardiac opacity. Finding represents
pneumonia.
.
.
[**1-9**] CXR:
IMPRESSION:
1. Improvement of the right lung base opacity.
2. Unchanged appearance of the left lung base opacity that could
represent
aspiration pneumonia.


Brief Hospital Course:
Patient expired on [**2171-1-18**].

Pt is 74-y/o male with chronic CHF [**2-11**] idiopathic dilated CMP
(LVEF 20-25%) and h/o VT on amioderone s/p BiV-ICD placement,
who originally p/w VT and ICD firings to an OSH, and was
subsequently transferred to [**Hospital1 18**] for further management.
.
# PUMP: Per report, hx of idiopathic dilated CMP, unknown EF
upon arrival. Patient euvolemic on exam on presentation, with no
impressive LE edema, no fluid overload on CXR, CVP at 7cm. He
was continued on his home regimen of [**Last Name (un) **], Carvedilol,
Spironolactone, and Lasix. Digoxin was held in the setting of
VT. TTE was obtained which showed EF 20-25% with akineseis of
interior, interolateral, lateral walls and distal [**1-12**] of the
ventricle as well as severe focal hypokinesis of the apical free
wall of the right ventricle + moderate to severe MR (3+) and
severe pulmonary artery hypertension. He became hypotensive, was
given multiple fluid boluses, and was tranferred to the CCU for
dopamine drip.  A central line was placed, and he was found to
have elevated CVP consistent with worsening heart failure. The
decision was made after converations with his family to
transition to comfort measures only.  Pressors and other
medications were stopped except morphine for comfort.  He
expired two days later.
.
# RHYTHM: Patient with reports of multiple recurrent VT and ICD
firings, but no EKG of VT in records or EPS performed at OSH.
Unclear if patient symptomatic during episodes. Per records,
attempt at ablation was aborted [**2-11**] to hypoxia/hypotension at
[**Location (un) 33663**]. Patient transferred in A-sense/V-paced rhythm, on
amiodarone gtt and lidocaine gtt, with PRN lidocaine boluses. On
further investigation was found to have poor LV lead placement
and this lead was deactivated. On [**1-4**] he was brought to the EP
lab for limited VT endocardial ablation, but arrhythmia could
not be induced. It was felt that he would need an epicardial
ablation, however this was not performed at this time because of
elevated WBC count and finding of pneumonia on CXR. He was
intubated during the procedure and remained on mechanical
ventilation until [**1-7**]. Pt was switched to amiodarone PO and
mexilitene PO was started. Lidocaine gtt weaned and
discontinued. All anti-arrhythmics were discontinued when the
decision was made to transition to comfort care.
.
# CORONARIES: Patient denies history of MI or CP, and no hx of
CAD per OSH records.
.
# VALVES: 2+ AR, 3+ MR likely [**2-11**] dilated CMP.
.
# Respiratory failure: Pt transferred with episodes of VT and
hospital-acquired PNA. Ablation was attempted urgently given
difficulty to control with meds. Pt required reintubation
post-procedure because of hypoxemia likely [**2-11**] worsening PNA and
pulmonary edema. Pt's condition improved with diuresis and abx.
Extubation was successfully performed on [**2171-1-7**].
.
# Acute renal failure:  Pt developed progressively decreasing
urine output and increasing creatinine, likely secondary to poor
forward flow from CHF.
.
# Hospital-acquired Pneumonia: Patient with temp of 101.2
rectally on admission, and later spiked to 102F on [**1-4**]. WBC of
16 w left-shift. CXR showed a LLL pneumonia, and he was treated
with a 10-day course of Zosyn and Vancomycin to cover for
hospital-acquired pneumonia given that pt has been hospitalized
since [**2170-12-24**]. Blood, urine and sputum cultures were
negative. When he became hypotensive and urine output decreased,
he was again short of breath, adn vancomycin and zosyn were
restarted empirically for potentially incompletely treated
hospital-acquired pneumonia.  These were stopped when he
transitioned to comfort measures only.
.
# Hypothyroidism: Patient with markedly elevated TSH at OSH.
Normal here.
.
# Hyperlipidemia: Continued lipitor.
.
# Hiccups: pt developed episodes of hiccups. Promethazine was
started.
.
# Anxiety/?AMS: Pt received ativan prn anxiety. Social work was
consulted for stress management and family coping.
.

Medications on Admission:
Home Medications:
Lipitor 40mg daily
Lorazepam 0.25mg PRN
Spironolactone 50mg daily
Lasix 60mg qam; 20mg qPM
Amiodarone 200mg daily
Digoxin 0.125mg daily
Cozaar 25mg daily
Coreg 3.125 [**Hospital1 **]
Coumadin
Allopurinol
.
Medications at Transfer:
Spironolactone 50mg daily
Lasix 20mg qpm
Lasix 60mg qam
Carvedilol 3.125mg [**Hospital1 **]
Lipitor 40mg daily
Losartan 25mg daily
Allopurinol 100mg [**Hospital1 **]
Lidocaine gtt
Baclofen 10mg q8 PRN
Alprazolam 0.25mg q12 PRN
Amiodarone ggt


Discharge Disposition:
Expired

Discharge Diagnosis:
patient expired

Discharge Condition:
expired


Completed by:[**2171-1-18**]
{'Paroxysmal ventricular tachycardia,Pneumonia, organism unspecified,Other primary cardiomyopathies,Chronic systolic heart failure,Acute kidney failure, unspecified,Cardiogenic shock,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Heparin-induced thrombocytopenia (HIT),Automatic implantable cardiac defibrillator in situ'}


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: VT storm

PRESENT ILLNESS: Pt is a 74-year-old male with a history of idiopathic dilated
cardiomyopathy s/p CRT/D (ICD), VT on amioderone, admitted to
OSH with [**Hospital **] transfered to [**Hospital1 18**] for possible VT ablation.
Patient is poor historian, and information taken from transfer
paperwork. Patient began to experience ICD firing 2 months prior
to presentation. At that time, he was advised to take
amioderone/mexiletine, but patient declined mexiletine due to
concern of polypharmacy. On [**12-24**], patient's ICD again fired,
and was admitted to [**Hospital 27292**] hospital. It appears that patient
was asymptomatic to VT, and only felt a premonatory fluttering
before shock. He denies any chest pain, SOB, lightheadedness, or
syncope. While admitted, patient had recurrent VT, and was
transfered to [**Hospital 33663**] Hospital for VT ablation on [**12-31**]. During
that hospitalization, he was on azithro/zosyn, but does not
appear patient had any clear infection.
.
At [**Location (un) 33663**], despite being managed on amioderone/lidocaine,
patient had recurrent VT, which was reportedly broken with both
ATP pacing and ICD firing. Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 81446**] attempted a VT
ablation. The patient became hypotensive and hypoxic during the
procedure, and case was aborted. The patient was continued on
amiodarone/lidocaine, and intially transitioned to mexiletine,
but with recurrent VT, lidocaine was re-intiated. Patient
transfered to [**Hospital1 18**] for further manegement.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, cough, hemoptysis, black stools or
red stools. He denies recent fevers, chills or rigors. He denies
exertional buttock or calf pain. The patient says he has been
experiencing a productive cough. All of the other review of
systems were negative.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: Dyslipidemia
2. CARDIAC HISTORY:
-PACING/ICD: BiV-ICD
3. OTHER PAST MEDICAL HISTORY:
.
Idiopathic CM with NYHF III
Mod-Sev MR
Mild AS
VT on amioderone
B/L Knee OA s/p R Knee replacement [**2169**]
Gout
Unclear why on coumadin

MEDICATION ON ADMISSION: Home Medications:
Lipitor 40mg daily
Lorazepam 0.25mg PRN
Spironolactone 50mg daily
Lasix 60mg qam; 20mg qPM
Amiodarone 200mg daily
Digoxin 0.125mg daily
Cozaar 25mg daily
Coreg 3.125 [**Hospital1 **]
Coumadin
Allopurinol
.
Medications at Transfer:
Spironolactone 50mg daily
Lasix 20mg qpm
Lasix 60mg qam
Carvedilol 3.125mg [**Hospital1 **]
Lipitor 40mg daily
Losartan 25mg daily
Allopurinol 100mg [**Hospital1 **]
Lidocaine gtt
Baclofen 10mg q8 PRN
Alprazolam 0.25mg q12 PRN
Amiodarone ggt

ALLERGIES: Codeine / Demerol / Heparin Agents

PHYSICAL EXAM: VS: T=98 BP=114/63 HR=92 RR=14
GENERAL: Diaphoretic male, appears uncomfortable, moaning in
pain. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Right pupil RRL, Anasacoria of
left pupil EOMI. Conjunctiva were pink, no pallor or cyanosis of
the oral mucosa. No xanthalesma.
NECK: Supple with JVP of 8 cm.
CARDIAC: PMI laterally displaced RR, normal S1, ? paradoxically
spit s2, + s4, [**2-15**] early intiated blowing murmur loudest at
apex. No thrills, lifts.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Trace UE edema, no pre-tibial edema
SKIN: ? infected papule in LUE, LLE slightly cool
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 1+ DP diminished
Left: Carotid 2+ Femoral 2+ Popliteal 1+ DP diminished

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: No Quit smoking:
-ETOH: Denies
-Illicit drugs: No 

### Response:
{'Paroxysmal ventricular tachycardia,Pneumonia, organism unspecified,Other primary cardiomyopathies,Chronic systolic heart failure,Acute kidney failure, unspecified,Cardiogenic shock,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Heparin-induced thrombocytopenia (HIT),Automatic implantable cardiac defibrillator in situ'}
