CHIEF COMPLAINT: Transferred from OSH for cardiac catheterization and ICD
placement s/p VF arrest

PRESENT ILLNESS: Patient is a 59 yr old male with PMHx of CAD s/p prior MI and
stents placed 5 years ago transferred from LGH s/p VF arrest.
Patient arrested on [**2134-11-9**] while at work driving a fork lift.
Fork lift crashed into wall, although pt did not have any
traumatic injury from that.  Shocked in the field x 3 by an AED
at his workplace.  He was down for almost 8 minutes.  He was
sent to LGH and found to have decorticate posturing by ER MD.
EKG on arrival was reviewed by Dr. [**Last Name (STitle) **] at LGH and it was not
felt that pt had an STEMI. (0.5mm STE in (1 and AVF).  He was
intubated and underwent Artic Sun cooling protocol.  He was
extubated x 3 days.  Since rewarming, he was found to be
neurologically intact.  ECHO showed EF 30% with RV hypokinesis.
He was also hypoxic with concern for COPD flare vs CHF
exacerbation.  He was treated with nebs, PO steroids as well as
lasix.  Patient was transferred to [**Hospital1 18**] for cath to r/o CAD and
subsequent ICD placement.
.
On arrival to [**Hospital1 18**], patient was hemodynamically stable.  He was
admitted to [**Hospital Ward Name 121**] 3 but was found to be hypotensive to 60s.  This
initially responded well to fluids but he then experienced
another hypotensive episode to the 70s.  The patient denied
chest pain, shortness of breath, dizziness, or lightheadedness.
No syncopal events occurred.  He also has occasional episodes of
hypoxia down the the 80s but denies shortness of breath.  He is
currently on IV heparin and IV amiodarone.  He is being
transferred to the CCU for closer monitoring.
.
He is currently endorsing left hip pain, LLQ pain.  This started
last night.  He is lightheaded when sitting up.
.
On review of systems, s/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.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, +
Hypertension
2. CARDIAC HISTORY: s/p inferior STEMI [**7-17**] with 2 [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 10157**]
placed to RCA and LCx
PERCUTANEOUS CORONARY INTERVENTIONS:
-[**2129-7-31**]- The mid LCX had an 80% stenosis. The RCA was occluded
in the proximal/mid segment without receiving significant
collaterals. Successful PCI of the proximal/mid RCA with a 3.0 x
23 mm Cypher
DES, post-dilated with a 3.5 mm balloon.
-[**2129-8-3**]- The LMCA and LAD were non-obstructed, and the LCX had
an 80% lesion after a large OM bifurcation. The RCA stent was
widely patent. Successful PCI of the LCX with a 3.0 x 23 mm
Cypher DES.
3. OTHER PAST MEDICAL HISTORY:
HTN
Asthma
Hypercholesterolemia
h/o spinal surgery [**2128**]

MEDICATION ON ADMISSION: Home:
1.  Aspirin 81 mg daily
2.  Combivent, unknown dose
.
Transfer:
1. Gabapentin 300 mg PO/NG [**Hospital1 **]
2. Acetaminophen 325-650 mg PO/NG Q6H:PRN Pain
3. Heparin IV Sliding Scale
4. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN SOB
5. Ipratropium Bromide Neb 1 NEB IH Q6H
6. Amiodarone 400 mg PO/NG TID
7. Aspirin EC 325 mg PO DAILY
8. Simvastatin 20 mg PO/NG DAILY
9. CeftriaXONE 2 gm IV Q24H
10. Doxycycline Hyclate 100 mg PO Q12H
11. Vancomycin 1000 mg IV Q 12H

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On transfer to CCU:

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

SOCIAL HISTORY: -Tobacco history: Quit tobacco in [**2123**]
-ETOH: denies
-Illicit drugs: None
Ventricular fibrillation,Hemoperitoneum (nontraumatic),Chronic obstructive asthma with (acute) exacerbation,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypotension, unspecified,Percutaneous transluminal coronary angioplasty status
Ventricular fibrillation,Hemoperitoneum,Ch obst asth w (ac) exac,Ac posthemorrhag anemia,Crnry athrscl natve vssl,Old myocardial infarct,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypotension NOS,Status-post ptca
Admission Date:  [**2134-11-15**]              Discharge Date:   [**2134-11-24**]

Date of Birth:  [**2075-8-13**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
Transferred from OSH for cardiac catheterization and ICD
placement s/p VF arrest

Major Surgical or Invasive Procedure:
pRBC blood transfusion
Cardiac catheterization
ICD placement

History of Present Illness:
Patient is a 59 yr old male with PMHx of CAD s/p prior MI and
stents placed 5 years ago transferred from LGH s/p VF arrest.
Patient arrested on [**2134-11-9**] while at work driving a fork lift.
Fork lift crashed into wall, although pt did not have any
traumatic injury from that.  Shocked in the field x 3 by an AED
at his workplace.  He was down for almost 8 minutes.  He was
sent to LGH and found to have decorticate posturing by ER MD.
EKG on arrival was reviewed by Dr. [**Last Name (STitle) **] at LGH and it was not
felt that pt had an STEMI. (0.5mm STE in (1 and AVF).  He was
intubated and underwent Artic Sun cooling protocol.  He was
extubated x 3 days.  Since rewarming, he was found to be
neurologically intact.  ECHO showed EF 30% with RV hypokinesis.
He was also hypoxic with concern for COPD flare vs CHF
exacerbation.  He was treated with nebs, PO steroids as well as
lasix.  Patient was transferred to [**Hospital1 18**] for cath to r/o CAD and
subsequent ICD placement.
.
On arrival to [**Hospital1 18**], patient was hemodynamically stable.  He was
admitted to [**Hospital Ward Name 121**] 3 but was found to be hypotensive to 60s.  This
initially responded well to fluids but he then experienced
another hypotensive episode to the 70s.  The patient denied
chest pain, shortness of breath, dizziness, or lightheadedness.
No syncopal events occurred.  He also has occasional episodes of
hypoxia down the the 80s but denies shortness of breath.  He is
currently on IV heparin and IV amiodarone.  He is being
transferred to the CCU for closer monitoring.
.
He is currently endorsing left hip pain, LLQ pain.  This started
last night.  He is lightheaded when sitting up.
.
On review of systems, s/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:
PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, +
Hypertension
2. CARDIAC HISTORY: s/p inferior STEMI [**7-17**] with 2 [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 10157**]
placed to RCA and LCx
PERCUTANEOUS CORONARY INTERVENTIONS:
-[**2129-7-31**]- The mid LCX had an 80% stenosis. The RCA was occluded
in the proximal/mid segment without receiving significant
collaterals. Successful PCI of the proximal/mid RCA with a 3.0 x
23 mm Cypher
DES, post-dilated with a 3.5 mm balloon.
-[**2129-8-3**]- The LMCA and LAD were non-obstructed, and the LCX had
an 80% lesion after a large OM bifurcation. The RCA stent was
widely patent. Successful PCI of the LCX with a 3.0 x 23 mm
Cypher DES.
3. OTHER PAST MEDICAL HISTORY:
HTN
Asthma
Hypercholesterolemia
h/o spinal surgery [**2128**]


Social History:
-Tobacco history: Quit tobacco in [**2123**]
-ETOH: denies
-Illicit drugs: None

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

Physical Exam:
On transfer to CCU:

GENERAL: Cachetic male in 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 no JVD.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, ND.  tender in LLQ, firm, no rebound, guarding.
No HSM or tenderness. Abd aorta not enlarged by palpation. No
abdominial 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:
Admission Labs:

[**2134-11-15**] 05:02PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.014
[**2134-11-15**] 05:02PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2134-11-15**] 05:02PM URINE  RBC-0-2 WBC-[**4-16**] BACTERIA-RARE YEAST-NONE
EPI-0-2
[**2134-11-15**] 05:02PM URINE  HYALINE-0-2
[**2134-11-15**] 05:02PM URINE  MUCOUS-MOD
[**2134-11-15**] 04:18PM   GLUCOSE-144* UREA N-22* CREAT-0.6 SODIUM-140
POTASSIUM-3.5 CHLORIDE-97 TOTAL CO2-37* ANION GAP-10
[**2134-11-15**] 04:18PM   estGFR-Using this
[**2134-11-15**] 04:18PM   CK(CPK)-397*
[**2134-11-15**] 04:18PM   CK-MB-3 cTropnT-<0.01
[**2134-11-15**] 04:18PM   CALCIUM-9.3 PHOSPHATE-2.6* MAGNESIUM-2.0
[**2134-11-15**] 04:18PM   WBC-16.9*# RBC-3.81* HGB-11.8* HCT-33.5*
MCV-88 MCH-30.9 MCHC-35.1* RDW-14.1
[**2134-11-15**] 04:18PM   PLT COUNT-235
[**2134-11-15**] 04:18PM   PT-12.0 PTT-50.5* INR(PT)-1.0
[**2134-11-15**] 03:35PM   TYPE-ART PO2-57* PCO2-47* PH-7.52* TOTAL
CO2-40* BASE XS-13
[**2134-11-15**] 03:35PM   LACTATE-1.9

CTA-Torso [**11-16**]:
1. Massive left-sided retroperitoneal hematoma involving the
left pararenal
spaces, with intramuscular component in left psoas, iliopsoas,
iliacus and
proximal anterior thigh compartment. There is suggestion of
active bleeding
within the left psoas muscle. Small right psoas hematoma also
present.

2. Multifocal pulmonary opacity with severe emphysema. In
conjunction with
the regions of bronchial wall thickening and impaction, the
lower lobe
opacities are likely infectious (possibly aspiration related)
while the
additional opacities may relate to superimposed
alveolar/interstitial edema,
hemorrhage, or additional sites of infection. Small left simple
pleural
effusion.

3. Atherosclerotic disease involving the coronary circulation,
aorta and
suggestion of high-grade focal stenosis involving the proximal
right renal
artery.

4. Abnormal thick-walled appearing sigmoid colon in conjunction
with
moderate-to-severe diverticulosis. While this may relate to
underlying
sequelae of acute or chronic diverticulitis, the lumen appears
irregular and a
colonoscopy or follow up CT is recommended when feasible to
exclude underlying
neoplasm.

5. No findings of aortic dissection or pulmonary embolism.
Mild-to-moderate
amount of ascites noted within the abdomen and pelvis.

TTE [**2134-11-17**]:
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thickness, cavity size, and global systolic
function are normal (LVEF>55%). Due to suboptimal technical
quality, a focal wall motion abnormality cannot be fully
excluded. Diastolic function could not be assessed. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. The left ventricular inflow pattern
suggests impaired relaxation. The tricuspid valve leaflets are
mildly thickened. The pulmonary artery systolic pressure could
not be determined. There is an anterior space which most likely
represents a prominent fat pad.

Cardiac Cath [**2134-11-18**]:
COMMENTS:
1. Selective coronary angiography in this right dominant system
demonstrated insignificant coronary artery disease.  The LMCA
was free
of angiographically apparent disease.  The LAD had a 20-30%
stenosis in
the mid vessel.  The LCx had a 40-50% stenosis in the first OM
branch.
The RCA had some ectatic dilation in the mid vessel at the
stent.  There
were minor 30% luminal irregularities.
2. Resting hemodynamics revealed low [**Hospital1 **]-ventricular pressures
with RVEDP
7mmHg and LVEDP 10mmHg.  The cardiac index was perserved at 3.42

l/min/m2.  There was no step-up consistent with a shunt.  There
was no
evidence of constriction or restrictive physiology.
3. There was no evidence of a gradient across the aortic valve
on
careful pullback of the angled pigtail from the left ventricle
to the
ascending aorta.
4. Left ventriculography was deferred.

FINAL DIAGNOSIS:
1. Coronary arteries have insignificant disease.
2. Normal right and left heart filling pressures.

Cardiac MR [**2134-11-19**]:
Prelim read - Basal/Inferior transmural enhancement c/w old
scar/prior MI; EF 49%.

LE LENIs [**2134-11-21**]:
No evidence for DVT in the bilateral lower extremities.

CXR PA-L [**2134-11-24**]:
IMPRESSION: PA and lateral chest compared to [**11-15**] through
[**11-23**] at
6:07 p.m.

A left trans-subclavian pacer defibrillator lead is unchanged in
position,with the proximal part of the distal electrode probably
in the tricuspid valve, and the tip short of the likely location
of the right ventricular apex. There is no pneumothorax or
mediastinal widening. Small bilateral pleural effusion has
increased, while moderate-to-severe peribronchial opacification
in the upper lungs has improved slightly on the left, worsened
on the right. If this patient is not experiencing hemoptysis or
recurrent aspiration, asymmetric pulmonary edema would be the
most likely explanation, given the rapidity of changes.
Emphysema is severe. Dr. [**First Name (STitle) 63778**] and I discussed the findings and
their clinical significance over the telephone at the time of
dictation.


Brief Hospital Course:
CCU Course:
59 yoM with h/o IMI (s/p LCx & RCA [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 10157**] [**2129**]) transferred
to [**Hospital1 18**] for Cath & ICD s/p VF arrest, initially in CCU for
symptomatic hypotension due to a venous RP bleed.
.
# Hypotension due to RP hemorrhage:  Presented to CCU with
symptomatic hypotension and palor. CTA torso showed large L > R
RP hemorrhage with question of sigmoid thickening, unable to
rule out sigmoid luminal irregularity. IR and vascular surgery
were consulted and deferred percutaneous or operative
intervention. Anticoagulation was held and the patient received
4U PRBCs on night of transfer to the CCU with appropriate HCT
response. When DVT prophylaxis with sub-cutanous Lovenox was
subsequently restarted, Hct transiently dropped and the patient
was transfused another unit of PRBCs with an appropriate
response; thereafter his Hct remained stable and pressures were
normotensive. He will require outpatient work-up of the
underlying cause of his RP bleed; in the absence of any known
instrumentation to the left groin and given the luminal
irregularities noted on CT, the leading diagnosis is GI neoplasm
- colonoscopy is indicated after discharge.

# VF Arrest, CAD: After resuscitation and cooling protocol at an
OSH, was transferred to [**Hospital1 18**] for catheterization and ICD
placement. EKG on admission was consistent with inferior
ischemia superimposed on old inferior infarct. Catheterization
showed no significant coronary vessel disease. Preliminary
cardiac MRI was suggestive of the VF arrest being due to old
scar. Echo results are detailed above. The patient underwent
successful ICD placement. The patient was discharged on ASA,
Simvastatin, Lisinopril, and Metoprolol for secondary
prevention.

# Hypoxia: Given the findings on CT in the setting of fever, was
transferred to the CCU on empiric antibiotics for presumed
hospital-acquired pneumonia; however, in the absence of any
clinical evidence supporting this diagnosis, antibiotics were
stopped. His presentation seemed more consistent with a COPD
flare given his history; he was treated accordingly with
albuterol and ipratropium nebs, prednisone pulse, and
doxycycline. His hypoxia subsequently resolved. He was
discharged on Combivent and Fluticasone-Salmeterol. He will
require outpatient follow-up for full assessment of PFTs.

Medications on Admission:
Home:
1.  Aspirin 81 mg daily
2.  Combivent, unknown dose
.
Transfer:
1. Gabapentin 300 mg PO/NG [**Hospital1 **]
2. Acetaminophen 325-650 mg PO/NG Q6H:PRN Pain
3. Heparin IV Sliding Scale
4. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN SOB
5. Ipratropium Bromide Neb 1 NEB IH Q6H
6. Amiodarone 400 mg PO/NG TID
7. Aspirin EC 325 mg PO DAILY
8. Simvastatin 20 mg PO/NG DAILY
9. CeftriaXONE 2 gm IV Q24H
10. Doxycycline Hyclate 100 mg PO Q12H
11. Vancomycin 1000 mg IV Q 12H


Discharge Medications:
1. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for Pain.
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 Disk with Device(s)* Refills:*2*
5. metoprolol succinate 25 mg Tablet Sustained Release 24 hr
Sig: 0.5 Tablet Sustained Release 24 hr PO at bedtime.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
6. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) as needed for post-ICD for 2 days.
Disp:*8 Capsule(s)* Refills:*0*
7. Outpatient Lab Work
Please check Chem-7 on Friday [**11-26**] and call results to
Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] [**Telephone/Fax (1) 63309**]


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Retroperitoneal Bleed
Acute Blood Loss Anemia
Ventricular fibrillation Cardiac arrest
Chronic Obstructive Pulmonary Disease Exacerbation
Hyperlipidemia


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


Discharge Instructions:
It has been a privilege to take care of you in the hospital.

You were hospitalized for cardiac catheterization to determine
why your heart stopped and for placement of an implantable
cardiac defibrillator (ICD) to prevent your heart from stopping
again in the future. The cardiac catheterization and a cardiac
MR showed that your cardiac arrest may have been due to an old
scar in your heart from a previous heart attack, not from a new
heart attack. The ICD was placed prior to your discharge.

You were also treated for an exacerbation of your chronic
obstructive pulmonary disease with antibiotics and prednisone,
those medicines are now finished.

Your hospitalization was complicated by a drop in blood pressure
due to internal bleeding of unclear cause. The bleeding stopped
on its own without need for surgery and you received blood
transfusions to restore your blood levels. Your blood levels and
blood pressures remained stable after you were transfused, but
it is still unclear what caused your bleeding and you will need
to follow-up with your primary care physician for referral to
other specialists, including a gastrointestinal doctor, for
further testing.
.
The following changes were made to your medications:
# Started: Simvastatin 20 mg daily
# Started: Metoprolol Succinate 25 mg daily, please take at
night
# Continued: Aspirin 81 mg daily
# Started: Fluticasone-Salmeterol Diskus inhaled twice daily
# Continued: Combivent twice daily
# Started Cephalexin four times a day for 2 days to prevent an
infection at the ICD site
# Your Lisinopril was held at time of discharge for low blood
pressure and dehydration. You will need to talk to Dr. [**Last Name (STitle) **]
about starting this medicine at a low dose.
.
You will come back in 1 week to have the ICD checked. Please
leave the dressing on for 3 days, you can then remove, keeping
the strips in place and shower. No baths or pools until after
you are seen in the device clinic.

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name3 (LF) **]
Address: [**Street Address(2) 63779**], [**Location **],[**Numeric Identifier 21771**]
Phone: [**Telephone/Fax (1) 63309**]
When: Thursday, [**12-2**], 2:05PM

Department: CARDIAC SERVICES
When: TUESDAY [**2134-11-30**] at 11:00 AM
With:  DEVICE CLINIC [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Name: [**Last Name (LF) **],[**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
Address: [**Street Address(2) **]. [**Apartment Address(1) **], [**Location **],[**Numeric Identifier 21918**]
Phone: [**Telephone/Fax (1) 63780**]
When: Tuesday, [**2134-12-7**]:15AM

Department: CARDIAC SERVICES
When: MONDAY [**2135-1-3**] at 11:00 AM
With: [**First Name11 (Name Pattern1) 539**] [**Last Name (NamePattern4) 13861**], NP [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: MONDAY [**2135-1-3**] at 11:40 AM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Ventricular fibrillation,Hemoperitoneum (nontraumatic),Chronic obstructive asthma with (acute) exacerbation,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypotension, unspecified,Percutaneous transluminal coronary angioplasty status'}


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: Transferred from OSH for cardiac catheterization and ICD
placement s/p VF arrest

PRESENT ILLNESS: Patient is a 59 yr old male with PMHx of CAD s/p prior MI and
stents placed 5 years ago transferred from LGH s/p VF arrest.
Patient arrested on [**2134-11-9**] while at work driving a fork lift.
Fork lift crashed into wall, although pt did not have any
traumatic injury from that.  Shocked in the field x 3 by an AED
at his workplace.  He was down for almost 8 minutes.  He was
sent to LGH and found to have decorticate posturing by ER MD.
EKG on arrival was reviewed by Dr. [**Last Name (STitle) **] at LGH and it was not
felt that pt had an STEMI. (0.5mm STE in (1 and AVF).  He was
intubated and underwent Artic Sun cooling protocol.  He was
extubated x 3 days.  Since rewarming, he was found to be
neurologically intact.  ECHO showed EF 30% with RV hypokinesis.
He was also hypoxic with concern for COPD flare vs CHF
exacerbation.  He was treated with nebs, PO steroids as well as
lasix.  Patient was transferred to [**Hospital1 18**] for cath to r/o CAD and
subsequent ICD placement.
.
On arrival to [**Hospital1 18**], patient was hemodynamically stable.  He was
admitted to [**Hospital Ward Name 121**] 3 but was found to be hypotensive to 60s.  This
initially responded well to fluids but he then experienced
another hypotensive episode to the 70s.  The patient denied
chest pain, shortness of breath, dizziness, or lightheadedness.
No syncopal events occurred.  He also has occasional episodes of
hypoxia down the the 80s but denies shortness of breath.  He is
currently on IV heparin and IV amiodarone.  He is being
transferred to the CCU for closer monitoring.
.
He is currently endorsing left hip pain, LLQ pain.  This started
last night.  He is lightheaded when sitting up.
.
On review of systems, s/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.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: - Diabetes, + Dyslipidemia, +
Hypertension
2. CARDIAC HISTORY: s/p inferior STEMI [**7-17**] with 2 [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 10157**]
placed to RCA and LCx
PERCUTANEOUS CORONARY INTERVENTIONS:
-[**2129-7-31**]- The mid LCX had an 80% stenosis. The RCA was occluded
in the proximal/mid segment without receiving significant
collaterals. Successful PCI of the proximal/mid RCA with a 3.0 x
23 mm Cypher
DES, post-dilated with a 3.5 mm balloon.
-[**2129-8-3**]- The LMCA and LAD were non-obstructed, and the LCX had
an 80% lesion after a large OM bifurcation. The RCA stent was
widely patent. Successful PCI of the LCX with a 3.0 x 23 mm
Cypher DES.
3. OTHER PAST MEDICAL HISTORY:
HTN
Asthma
Hypercholesterolemia
h/o spinal surgery [**2128**]

MEDICATION ON ADMISSION: Home:
1.  Aspirin 81 mg daily
2.  Combivent, unknown dose
.
Transfer:
1. Gabapentin 300 mg PO/NG [**Hospital1 **]
2. Acetaminophen 325-650 mg PO/NG Q6H:PRN Pain
3. Heparin IV Sliding Scale
4. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN SOB
5. Ipratropium Bromide Neb 1 NEB IH Q6H
6. Amiodarone 400 mg PO/NG TID
7. Aspirin EC 325 mg PO DAILY
8. Simvastatin 20 mg PO/NG DAILY
9. CeftriaXONE 2 gm IV Q24H
10. Doxycycline Hyclate 100 mg PO Q12H
11. Vancomycin 1000 mg IV Q 12H

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On transfer to CCU:

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

SOCIAL HISTORY: -Tobacco history: Quit tobacco in [**2123**]
-ETOH: denies
-Illicit drugs: None 

### Response:
{'Ventricular fibrillation,Hemoperitoneum (nontraumatic),Chronic obstructive asthma with (acute) exacerbation,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypotension, unspecified,Percutaneous transluminal coronary angioplasty status'}
