CHIEF COMPLAINT: S/P Cardiac arrest

PRESENT ILLNESS: Mr. [**Known lastname 79067**] [**Last Name (Titles) **] a 64 yo male with a h/o morbid obesity, OSA, and
HTN who presents following a witnessed cardiac arrest.  Patient
does not recall the events preceding his admission to [**Hospital1 18**], and
history was obtained from OSH record and from wife.  [**Name (NI) **] report,
patient was at a wedding ceremony  He was in a seated position
when his wife heard a gurgling [**Last Name (un) **] and noted him to collapse
onto the ground.  There were medical personnel present and CPR
reported him to have a carotid pulse. EMS arrived and reported
him to be in ventricular fibrillation.  He was shocked x 1 at
200J and was returned to a perfusing rhythm.  No rhythm strips
are available.  Per report, a piece of chewing gum was suctioned
from the oropharynx during resuscitation.  There was no report
of urinary or fecal incontinence.
.
He was subsequently brought to the ED at [**Hospital 7188**] Hospital where
he was intubated. Per report, this was a "difficult intubation."
He was reported to be hemodynamically stable at time of arrival.
 CT head was reported as normal. He was admitted to the CCU and
supported overnight on a ventilator.  He was started on a
heparin gtt and amiodarone gtt at 0.5 mg/min.  he received ASA
325 mg and Lidocaine 100 mg IV.
.
On review of symptoms, 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. He denies recent fevers, chills or rigors.
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,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.  His family did endorse
episodes of dyspnea with exertion and diaphoresis.
.

MEDICAL HISTORY: Hypertension
OSA
Morbid obesity
Tobacco abuse

MEDICATION ON ADMISSION: HCTZ 25 mg daily
Lexapro 10 mg daily
Amoxicillin PRN dental work
Ibuprofen 800 mg TID
Verapamil 240 XR daily (has not been filled since [**Month (only) 116**], per CVS)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS: T 98, BP 156/75, HR 63, RR 18, O2 97% on 4 liters
Gen: obese middle aged male in NAD, resp or otherwise.  Mood,
affect appropriate. Pleasant.
NEURO: Oriented to person only.  Moving all extremities.  CN
[**3-1**] intact.  Continues to perseverate and repeat the same
questions regarding where he is, what happened.
HEENT: NCAT.  Ecchymoses over left side of tongue.  Sclera
anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or
cyanosis of the oral mucosa.
Neck: Thick, unable to assess JVP.
CV: Very distant heart sounds.  PMI located in 5th intercostal
space, midclavicular line. RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: Scar over left ankle, left knee.  Trace lower extremity
edema L>R.  No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: His father died in his 50's of an MI.

SOCIAL HISTORY: Social history is significant for the presence of current
tobacco use.  Patient states that he currently smokes [**1-19**] PPD.
There is no history of alcohol abuse.   He reports that he
consumes an average of 1 gin & tonic every night.
Ventricular fibrillation,Acute myocardial infarction of unspecified site, initial episode of care,Chronic airway obstruction, not elsewhere classified,Jaundice, unspecified, not of newborn,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Morbid obesity,Obstructive sleep apnea (adult)(pediatric),Tobacco use disorder,Anemia, unspecified,Other chronic nonalcoholic liver disease,Other diseases of lung, not elsewhere classified,Nontoxic uninodular goiter,Knee joint replacement,Mitral valve disorders,Osteoarthrosis, unspecified whether generalized or localized, site unspecified
Ventricular fibrillation,AMI NOS, initial,Chr airway obstruct NEC,Jaundice NOS,Crnry athrscl natve vssl,Hypertension NOS,Morbid obesity,Obstructive sleep apnea,Tobacco use disorder,Anemia NOS,Chronic liver dis NEC,Other lung disease NEC,Nontox uninodular goiter,Joint replaced knee,Mitral valve disorder,Osteoarthros NOS-unspec
Admission Date:  [**2107-9-11**]              Discharge Date:   [**2107-9-21**]

Date of Birth:  [**2042-10-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
S/P Cardiac arrest

Major Surgical or Invasive Procedure:
[**2107-9-14**] - CABGx3 (left internal mammary-> Left anterior
descending artery, Saphenous vein graft (SVG)-> Acute marginal
artery, SVG->Posterior descending artery.)
[**2107-9-12**] - Cardiac Catheterization


History of Present Illness:
Mr. [**Known lastname 79067**] [**Last Name (Titles) **] a 64 yo male with a h/o morbid obesity, OSA, and
HTN who presents following a witnessed cardiac arrest.  Patient
does not recall the events preceding his admission to [**Hospital1 18**], and
history was obtained from OSH record and from wife.  [**Name (NI) **] report,
patient was at a wedding ceremony  He was in a seated position
when his wife heard a gurgling [**Last Name (un) **] and noted him to collapse
onto the ground.  There were medical personnel present and CPR
reported him to have a carotid pulse. EMS arrived and reported
him to be in ventricular fibrillation.  He was shocked x 1 at
200J and was returned to a perfusing rhythm.  No rhythm strips
are available.  Per report, a piece of chewing gum was suctioned
from the oropharynx during resuscitation.  There was no report
of urinary or fecal incontinence.
.
He was subsequently brought to the ED at [**Hospital 7188**] Hospital where
he was intubated. Per report, this was a "difficult intubation."
He was reported to be hemodynamically stable at time of arrival.
 CT head was reported as normal. He was admitted to the CCU and
supported overnight on a ventilator.  He was started on a
heparin gtt and amiodarone gtt at 0.5 mg/min.  he received ASA
325 mg and Lidocaine 100 mg IV.
.
On review of symptoms, 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. He denies recent fevers, chills or rigors.
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,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.  His family did endorse
episodes of dyspnea with exertion and diaphoresis.
.


Past Medical History:
Hypertension
OSA
Morbid obesity
Tobacco abuse


Social History:
Social history is significant for the presence of current
tobacco use.  Patient states that he currently smokes [**1-19**] PPD.
There is no history of alcohol abuse.   He reports that he
consumes an average of 1 gin & tonic every night.


Family History:
His father died in his 50's of an MI.

Physical Exam:
PHYSICAL EXAMINATION:
VS: T 98, BP 156/75, HR 63, RR 18, O2 97% on 4 liters
Gen: obese middle aged male in NAD, resp or otherwise.  Mood,
affect appropriate. Pleasant.
NEURO: Oriented to person only.  Moving all extremities.  CN
[**3-1**] intact.  Continues to perseverate and repeat the same
questions regarding where he is, what happened.
HEENT: NCAT.  Ecchymoses over left side of tongue.  Sclera
anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or
cyanosis of the oral mucosa.
Neck: Thick, unable to assess JVP.
CV: Very distant heart sounds.  PMI located in 5th intercostal
space, midclavicular line. RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: Scar over left ankle, left knee.  Trace lower extremity
edema L>R.  No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP



Pertinent Results:
ADMISSION LABS:

[**2107-9-11**] 01:46PM BLOOD WBC-8.8 RBC-3.57* Hgb-12.0* Hct-34.0*
MCV-95 MCH-33.7* MCHC-35.3* RDW-19.1* Plt Ct-159
[**2107-9-11**] 01:46PM BLOOD Neuts-83.4* Lymphs-11.7* Monos-3.9
Eos-0.7 Baso-0.4
[**2107-9-11**] 01:46PM BLOOD PT-14.2* PTT-58.9* INR(PT)-1.2*
[**2107-9-11**] 01:46PM BLOOD Plt Ct-159
[**2107-9-11**] 01:46PM BLOOD Glucose-125* UreaN-11 Creat-0.9 Na-136
K-5.0 Cl-100 HCO3-27 AnGap-14
[**2107-9-11**] 01:46PM BLOOD CK(CPK)-185*
[**2107-9-11**] 01:46PM BLOOD CK-MB-10 MB Indx-5.4 cTropnT-0.07*
[**2107-9-11**] 01:46PM BLOOD Calcium-9.1 Phos-3.5 Mg-2.2 Cholest-159
[**2107-9-11**] 03:09PM BLOOD %HbA1c-5.1
[**2107-9-11**] 01:46PM BLOOD Triglyc-240* HDL-41 CHOL/HD-3.9
LDLcalc-70
[**2107-9-11**] 01:46PM BLOOD TSH-1.1
[**2107-9-11**] 01:46PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2107-9-14**] 09:41AM BLOOD Type-ART pO2-341* pCO2-44 pH-7.41
calTCO2-29 Base XS-3 Intubat-INTUBATED
[**2107-9-14**] 09:41AM BLOOD Glucose-119* Lactate-1.3 Na-135 K-4.7
Cl-99*
[**2107-9-14**] 09:41AM BLOOD Hgb-11.3* calcHCT-34

EKG demonstrated NSR, HR 60 with normal axis, normal intervals,
1mm ST depression in I.  No ST elevations.  Q waves present in
inferior leads.  No prior available for comparison.
.
TELEMETRY demonstrated: NSR, HR 60's
.
2D-ECHOCARDIOGRAM performed on [**2107-9-10**] at [**Hospital **] Hospital
demonstrated:  depressed left ventricular EF at 35-40% (no
official report available)
.
LABORATORY DATA (from OSH):
#1 CK 69, Trop 0.03
#2 CK 176, Trop 0.89
#3 CK 122, Trop 0.85
.
RADIOLOGY:
CXR ([**2107-9-11**]): cardiomegaly; left pleural effusion; mild
pulmonary vascular congestion without overt pulmonary edema;
tortuosity and narrowing of trachea noted

[**2107-9-13**] Carotid Ultrasound
Less than 40% stenosis of the internal carotid arteries
bilaterally. This is a baseline examination at the [**Hospital1 18**].

[**2107-9-13**] Thyroid ultrasound
1. Normal thyroid ultrasound.
2. Mass seen on recent CT not identified due to its retrosternal
location.
This could be further evaluated with non-contrast enhanced CT or
MRI.

[**2107-9-14**] ECHO
Pre Bypass: There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal for the
patient's body size. There is mild regional left ventricular
systolic dysfunction with mild septal and mid inferior
hypokinesis..The ascending aorta is mildly dilated. There are
complex (>4mm) atheroma in the aortic arch. The descending
thoracic aorta is mildly dilated. There are complex (>4mm)
atheroma in the descending thoracic aorta. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
a trivial/physiologic pericardial effusion.

Post Bypass: Preserved biventricular function. LVEF 50-55%.
Inferior wall motion slightly improved. Aortic contours intact.
Remaining exam unchanged. All findings discussed with surgeons
at the time of the exam.

[**2107-9-11**] CTA Chest
1. Superior mediastinal 3 cm mass, immediately contiguous with
the inferior aspect of the thyroid gland. Further evaluation
with thyroid son[**Name (NI) 867**] is recommended as clinically indicated.
The nodule is substernal and may be difficult to visualize
[**Name (NI) 79068**], however.
2. Intermediate attenuation 4.6 cm bulging along the contour of
the right
subscapularis muscle. Differential diagnosis would include a
mass such as a myxoma or elastofibroma or a cystic structure
such as a paralabral cyst or bursitis. As clinically indicated,
further evaluation with shoulder MRI is recommended.
3. Extensive coronary artery calcifications.
4. Tiny pulmonary nodules measuring 4 mm at the right lower lobe
adjacent to the major fissure and 3 mm in subpleural location
overlying the left lower lobe.

[**2107-9-12**] Cardiac Catheterization
1.  Selective coronary angiography of this right-dominant system

revealed two-vessel coronary disease.  The LMCA has no
angiographically-apparent stenoses.  The LAD has a proximal,
hazy,
ulcerated 80% stenosis and a calcified 50% mid-vessel stenosis.
The LCX
has mild diffuse luminal irregularities with no flow-limiting
stenoses.
The RCA has a proximal chronic total occlusion with brisk
collateralization from the LCA.
2.  Limited resting hemodynamics demonstrate moderate systemic
systolic
hypertension.


Brief Hospital Course:
Mr. [**Known lastname 79067**] was admitted to the [**Hospital1 18**] on [**2107-9-11**] via transfer
from [**Hospital 7188**] Hospital for further management of his cardiac
arrest. Cardiac catheterization showed multivessel coronary
disease. He was taken to the operating room on [**2107-9-14**] where
he underwent CABG x3. Please refer to Dr[**Doctor Last Name **] operative
report for further details. He was transferred to CVICU
intubated, hemodynamically stable. All lines and drains were
discontinued in a timely fashion. He was transferred to the SDU
for further tele monitoring and incresaed activity/ambulation.
Postoperative anemia was corrected with 1 unit of PRBCs and
diuresis. EP study on POD#6 showed VTach was not inducible. EP
reccommends to continue further beta-blocker, monitor
electrolytes until discharge, and repeat an echocardiogram at 3
months following discharge. During this admission Mr.[**Known lastname 79067**]
had hyperbilirubinemia. Right upper quadrant ultrasound was
performed and showed normal gallbladder, fatty liver, and
splenomegaly.  The patient made excellent progress with physical
therapy, showing good strength and balance before discharge.  By
the time of discharge on POD 7, the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.  He was discharged to home on POD#7.

Medications on Admission:
HCTZ 25 mg daily
Lexapro 10 mg daily
Amoxicillin PRN dental work
Ibuprofen 800 mg TID
Verapamil 240 XR daily (has not been filled since [**Month (only) 116**], per CVS)


Discharge Medications:
1. 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:*0*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
8. Zantac 150 mg Capsule Sig: One (1) Capsule PO once a day for
1 months.
Disp:*30 Capsule(s)* Refills:*0*
9. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
tba

Discharge Diagnosis:
CAD s/p CABGx3
HTN
OSA
Morbid obesity
Tobacco use
Cardiac arrest


Discharge Condition:
good


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Call with any questions or concerns.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Please follow-up with Dr. [**Last Name (STitle) **] in 2 weeks.



Completed by:[**2107-9-21**]
{'Ventricular fibrillation,Acute myocardial infarction of unspecified site, initial episode of care,Chronic airway obstruction, not elsewhere classified,Jaundice, unspecified, not of newborn,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Morbid obesity,Obstructive sleep apnea (adult)(pediatric),Tobacco use disorder,Anemia, unspecified,Other chronic nonalcoholic liver disease,Other diseases of lung, not elsewhere classified,Nontoxic uninodular goiter,Knee joint replacement,Mitral valve disorders,Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}


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: Mr. [**Known lastname 79067**] [**Last Name (Titles) **] a 64 yo male with a h/o morbid obesity, OSA, and
HTN who presents following a witnessed cardiac arrest.  Patient
does not recall the events preceding his admission to [**Hospital1 18**], and
history was obtained from OSH record and from wife.  [**Name (NI) **] report,
patient was at a wedding ceremony  He was in a seated position
when his wife heard a gurgling [**Last Name (un) **] and noted him to collapse
onto the ground.  There were medical personnel present and CPR
reported him to have a carotid pulse. EMS arrived and reported
him to be in ventricular fibrillation.  He was shocked x 1 at
200J and was returned to a perfusing rhythm.  No rhythm strips
are available.  Per report, a piece of chewing gum was suctioned
from the oropharynx during resuscitation.  There was no report
of urinary or fecal incontinence.
.
He was subsequently brought to the ED at [**Hospital 7188**] Hospital where
he was intubated. Per report, this was a "difficult intubation."
He was reported to be hemodynamically stable at time of arrival.
 CT head was reported as normal. He was admitted to the CCU and
supported overnight on a ventilator.  He was started on a
heparin gtt and amiodarone gtt at 0.5 mg/min.  he received ASA
325 mg and Lidocaine 100 mg IV.
.
On review of symptoms, 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. He denies recent fevers, chills or rigors.
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,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.  His family did endorse
episodes of dyspnea with exertion and diaphoresis.
.

MEDICAL HISTORY: Hypertension
OSA
Morbid obesity
Tobacco abuse

MEDICATION ON ADMISSION: HCTZ 25 mg daily
Lexapro 10 mg daily
Amoxicillin PRN dental work
Ibuprofen 800 mg TID
Verapamil 240 XR daily (has not been filled since [**Month (only) 116**], per CVS)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS: T 98, BP 156/75, HR 63, RR 18, O2 97% on 4 liters
Gen: obese middle aged male in NAD, resp or otherwise.  Mood,
affect appropriate. Pleasant.
NEURO: Oriented to person only.  Moving all extremities.  CN
[**3-1**] intact.  Continues to perseverate and repeat the same
questions regarding where he is, what happened.
HEENT: NCAT.  Ecchymoses over left side of tongue.  Sclera
anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or
cyanosis of the oral mucosa.
Neck: Thick, unable to assess JVP.
CV: Very distant heart sounds.  PMI located in 5th intercostal
space, midclavicular line. RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: Scar over left ankle, left knee.  Trace lower extremity
edema L>R.  No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: His father died in his 50's of an MI.

SOCIAL HISTORY: Social history is significant for the presence of current
tobacco use.  Patient states that he currently smokes [**1-19**] PPD.
There is no history of alcohol abuse.   He reports that he
consumes an average of 1 gin & tonic every night. 

### Response:
{'Ventricular fibrillation,Acute myocardial infarction of unspecified site, initial episode of care,Chronic airway obstruction, not elsewhere classified,Jaundice, unspecified, not of newborn,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Morbid obesity,Obstructive sleep apnea (adult)(pediatric),Tobacco use disorder,Anemia, unspecified,Other chronic nonalcoholic liver disease,Other diseases of lung, not elsewhere classified,Nontoxic uninodular goiter,Knee joint replacement,Mitral valve disorders,Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}
