CHIEF COMPLAINT: Vfib arrest

PRESENT ILLNESS: Mr. [**Known lastname 11041**] is a 42 yo male with a history of hyperlipidemia who
collapsed while playing soccer on the evening of admission.  911
was called at approx 9:30pm after the patient had collapsed.
The fire department arrived first, and initiated CPR. ACD was
applied, and reportedly the patient was shocked x 1 for VFIB
(strip not available).  EMS team arrived at 9:40 PM, pt in
asystole at that time. CPR continued, ACLS started and pt given
epi x 2 and atropine x 1 at which point he developed sinus brady
at 57 and SBP 110/70.  He was intubated in the field and
transported to OSH.
.
The patient's wife reports that the patient had complained of
chest pain during exercise over the past few months. No reports
of pain today. Wife reports he had no recent complaints of
fever/chills at home. No complaints of dyspnea. No significant
PMH with the exception of hyperlipidemia for which he took
medication.
.
At the OSH: Initial Vitals: HR 50-60, BP 100-110/60-70s,
afebrile. WBC: 11, Hct 43.4, Plt 211, Na 138, K 3.5, Cl 100, CO2
17, Glc 272, BUN 31, Cr 1.4, CK 426, MB 3.8, I 0.8, TropI 0.09
(nl 0-0.3).  Started on lidocaine gtt, propofol gtt, given ASA
325 PR, ativan 1 mg IV, 1 L NS.  GCS = 4 per [**Location (un) **] note.
.
[**Location (un) 7622**] to [**Hospital1 18**] CCU at request of family.
.
ROS: Unable to obtain.

MEDICAL HISTORY: Hyperlipidemia
No history of hypertension or diabetes

MEDICATION ON ADMISSION: Unknown medication for high cholesterol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
VS: T 99.8, HR 80 BP 117/75, RR 19, O2 100% on AC 500x20, 60%,
PEEP 5.
Gen: intubated, sedated, nonresponsive.
HEENT: NCAT. Sclera anicteric. PERRL 4->2 b/l. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without JVD
CV: 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, ND, No HSM. No abdominial bruits.
Ext: Cool to touch. No c/c/e. 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: There is no family history of premature coronary artery disease
or sudden death. Father died of MI at age 60s, grandfather age
80s. [**Name2 (NI) **] history of arrhythmia. No recent travel. Pt moved to the
US at age 20.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse or drug use.
Acute myocardial infarction of unspecified site, initial episode of care,Ventricular fibrillation,Other and unspecified hyperlipidemia,Family history of ischemic heart disease,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Nausea alone,Other and unspecified superficial injury of face, neck, and scalp, without mention of infection,Accidental fall from bed,Accidents occurring in residential institution
AMI NOS, initial,Ventricular fibrillation,Hyperlipidemia NEC/NOS,Fam hx-ischem heart dis,Crnry athrscl natve vssl,Hypertension NOS,Nausea alone,Superfic inj head NEC,Fall from bed,Accid in resident instit
Admission Date:  [**2178-12-17**]              Discharge Date:   [**2178-12-24**]

Date of Birth:  [**2135-12-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 134**]
Chief Complaint:
Vfib arrest

Major Surgical or Invasive Procedure:
Cardiac Catheterization

History of Present Illness:
Mr. [**Known lastname 11041**] is a 42 yo male with a history of hyperlipidemia who
collapsed while playing soccer on the evening of admission.  911
was called at approx 9:30pm after the patient had collapsed.
The fire department arrived first, and initiated CPR. ACD was
applied, and reportedly the patient was shocked x 1 for VFIB
(strip not available).  EMS team arrived at 9:40 PM, pt in
asystole at that time. CPR continued, ACLS started and pt given
epi x 2 and atropine x 1 at which point he developed sinus brady
at 57 and SBP 110/70.  He was intubated in the field and
transported to OSH.
.
The patient's wife reports that the patient had complained of
chest pain during exercise over the past few months. No reports
of pain today. Wife reports he had no recent complaints of
fever/chills at home. No complaints of dyspnea. No significant
PMH with the exception of hyperlipidemia for which he took
medication.
.
At the OSH: Initial Vitals: HR 50-60, BP 100-110/60-70s,
afebrile. WBC: 11, Hct 43.4, Plt 211, Na 138, K 3.5, Cl 100, CO2
17, Glc 272, BUN 31, Cr 1.4, CK 426, MB 3.8, I 0.8, TropI 0.09
(nl 0-0.3).  Started on lidocaine gtt, propofol gtt, given ASA
325 PR, ativan 1 mg IV, 1 L NS.  GCS = 4 per [**Location (un) **] note.
.
[**Location (un) 7622**] to [**Hospital1 18**] CCU at request of family.
.
ROS: Unable to obtain.


Past Medical History:
Hyperlipidemia
No history of hypertension or diabetes

Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse or drug use.

Family History:
There is no family history of premature coronary artery disease
or sudden death. Father died of MI at age 60s, grandfather age
80s. [**Name2 (NI) **] history of arrhythmia. No recent travel. Pt moved to the
US at age 20.

Physical Exam:
ADMISSION PHYSICAL EXAM
VS: T 99.8, HR 80 BP 117/75, RR 19, O2 100% on AC 500x20, 60%,
PEEP 5.
Gen: intubated, sedated, nonresponsive.
HEENT: NCAT. Sclera anicteric. PERRL 4->2 b/l. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without JVD
CV: 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, ND, No HSM. No abdominial bruits.
Ext: Cool to touch. No c/c/e. 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

NEURO: PERRL. Moves b/l LE in response to pain. Did not see any
UE movement, (though UE movement documented in OSH note).
Babinski mute b/l. No clonus. +cough, uncertain if gag reflex.


Pertinent Results:
OSH EKG: NSR at 63, TW depression V3, TW depression V4 V5,
unable to interpret leads aVR, aVL, aVF.
EKG on admission to CCU:  NSR at 67, nl axis, nl intervals, QTc
= 374. TWI III, Q in III. ?J point elevation in V2, V3. biphasic
T waves V3, V4. No prior available for comparision.
.

[**2178-12-17**] 02:30AM   WBC-10.7 RBC-4.76 HGB-15.1 HCT-42.6 MCV-89
MCH-31.6 MCHC-35.4* RDW-12.8
[**2178-12-17**] 02:30AM   NEUTS-82.9* LYMPHS-11.5* MONOS-5.2 EOS-0.3
BASOS-0.1
[**2178-12-17**] 02:30AM   PLT COUNT-203
[**2178-12-17**] 02:30AM   PT-13.5* PTT-23.5 INR(PT)-1.2*
[**2178-12-17**] 02:26AM   GLUCOSE-114* LACTATE-1.8 NA+-138 K+-5.0
[**2178-12-17**] 02:26AM   freeCa-1.19
[**2178-12-17**] 02:30AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2178-12-17**] 02:30AM   TRIGLYCER-74 HDL CHOL-49 CHOL/HDL-2.9
LDL(CALC)-80
[**2178-12-17**] 02:30AM   ALBUMIN-4.0 CALCIUM-8.8 PHOSPHATE-3.2
MAGNESIUM-2.1 CHOLEST-144
[**2178-12-17**] 02:30AM   CK-MB-41* MB INDX-6.1* cTropnT-2.43*
[**2178-12-17**] 02:30AM   ALT(SGPT)-115* AST(SGOT)-126* LD(LDH)-278*
CK(CPK)-670* ALK PHOS-96 TOT BILI-0.4
[**2178-12-17**] 02:30AM   GLUCOSE-116* UREA N-31* CREAT-1.4* SODIUM-140
POTASSIUM-5.6* CHLORIDE-106 TOTAL CO2-27 ANION GAP-13
[**2178-12-17**] 03:53AM URINE  RBC-[**1-27**]* WBC-0-2 BACTERIA-RARE
YEAST-NONE EPI-0-2 TRANS EPI-0-2
[**2178-12-17**] 03:53AM URINE  BLOOD-TR NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2178-12-17**] 03:53AM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2178-12-17**] 08:06AM   CK-MB-49* MB INDX-7.5* cTropnT-0.76*
[**2178-12-17**] 08:06AM   CK(CPK)-651*
[**2178-12-17**] 04:39PM   CK-MB-80* MB INDX-9.1* cTropnT-1.11*
[**2178-12-17**] 04:39PM   CK(CPK)-877*
.
[**2178-12-17**] TTE:
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy with normal cavity size. There is severe
global left ventricular hypokinesis. Quantitative (biplane) LVEF
= 20%. No masses or thrombi are seen in the left ventricle.
Right ventricular chamber size is normal. with mild global free
wall hypokinesis. The aortic root is mildly dilated at the sinus
level. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic regurgitation. The
mitral valve leaflets are structurally normal. There is no
mitral valve prolapse. Mild (1+) mitral regurgitation is seen.
The estimated pulmonary artery systolic pressure is normal.
There is no pericardial effusion.

IMPRESSION: Mild symmetric left ventricular hypertrophy with
severe global systolic dysfunction. Mild right ventricular
systolic dysfunction. No asymmetric septal hypertrophy, marked
regional variability in LV wall motion, or significant valvular
disease seen.
.
[**2178-12-18**] CT Head:
There is no evidence of hemorrhage, masses, shift of normally
midline structures, hydrocephalus, or major vascular territorial
infarct. No abnormalities are seen in the globus pallidi,
hippocampal region, or watershed areas of the cortex. Ventricles
and sulci are normal in contour and configuration. No fractures
are identified.

Air-fluid levels are seen in the sphenoid, ethmoid, and
maxillary air cells. Endotracheal intubation is noted on the
scout film.

IMPRESSION: No intracranial abnormalities.

[**2178-12-18**] Cardiac Catheterization
1. Selective coronary angiography of this right dominant system
demonstrated a single vessel CAD.  The LMCA had a 20% distal
stenosis.
The LAD had a 90% stenosis at the bifurcation with a moderately
sized
D1.  The mid LAD had a 30% stenosis.  The LCX was patent.  The
RCA had a
20% distal vessel stenosis.
2. Limited resting hemodynamics revealed an elevated left sided
filling
pressure with an LVEDP of 19 mmHg.
3. Left ventriculography was deferred.
4. Successful PTA of the first diagonal with a 2.5x12mm
voyager balloon. Successful ptca and stenting of the proximal
LAD with a
3.0x18mm cypher stent which was post-dilated to 3.25mm. Final
angiography revealed 0% residual stenosis in the LAD, 20%
residual
stenosis in the ostium of D1. The patient left hemodynamically
stable
and back to the CCU for further treatment.

Brief Hospital Course:
ACUTE MYOCARDIAL INFARCTION
The patient had a myocardial infarction while playing soccer on
[**2178-12-17**].  He also suffered from VFib arrest and was given CPR on
the field.  On [**2178-12-18**], he underwent cardiac catheterization and
was found to have a 90% stenosis of the LAD; he received a
cypher stent in this vessel.  He was started on atorvastatin 80
mg QD as well as aspirin and plavix.  Echo on [**12-18**] showed an EF
of 20% with global hypokinesis, but repeat echo on [**12-22**] showed
an EF 60% likely reflecting recovery of the stunned myocardium.
There was no evidence of structural heart disease.  During his
event, he was intubated for airway protection and likely
suffered some degree of anoxic brain injury from the VFib
arrest.  He was initially very confused and agitated after his
extubation, but these symptoms resolved by the time of
discharge.  He did seem to have short term memory deficits at
the time of discharge, and it was thought he would benefit from
OT and PT in short term rehab before returning home.

HYPERTENSION
His high blood pressure was initially managed with metoprolol
37.5 mg TID; he was switched to metoprolol XL 100 mg QD with
good effect and discharged on that medicine.  He was also
started on lisinopril 5mg QD.

FEVERS
During his hospitalization, he had several low grade
temperatures and was found to have heavy growth of MSSA in his
sputum.  He was also found to have [**11-27**] vials of coagulase
negative staph in his blood cultures, likely a contaminant.  He
was started on a seven day course for the MSSA in his sputum
beginning on [**2178-12-22**] and defervesced.

Medications on Admission:
Unknown medication for high cholesterol

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
6. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 4 days: Continue through
[**2178-12-28**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital 5503**] [**Hospital **] Hospital

Discharge Diagnosis:
Acute myocardial infarction


Discharge Condition:
Stable-- with improved cardiac function; not short of breath or
dyspneic.  Still with some short term memory deficits from
likely anoxic brain injury but overall improved.


Discharge Instructions:
You should not do any running or exercise for the next several
weeks and until further advised by your cardiologist.  This is
because you had a mild heart attack should be reevaluated before
returning to your normal activity level.

There are several medications for your heart that you have been
started on because you had a heart attack.  You need to take
these until told to do so otherwise by your cardiologist.

Followup Instructions:
You should make an appointment to see your primary care doctor
in the next 1 - 2 weeks.  You should make an appointment to see
a cardiologist at [**Hospital1 **] Hospital in the next 2 -
3 weeks-- you can call ([**Telephone/Fax (1) 2037**] to make an appointment.
{'Acute myocardial infarction of unspecified site, initial episode of care,Ventricular fibrillation,Other and unspecified hyperlipidemia,Family history of ischemic heart disease,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Nausea alone,Other and unspecified superficial injury of face, neck, and scalp, without mention of infection,Accidental fall from bed,Accidents occurring in residential institution'}


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: Vfib arrest

PRESENT ILLNESS: Mr. [**Known lastname 11041**] is a 42 yo male with a history of hyperlipidemia who
collapsed while playing soccer on the evening of admission.  911
was called at approx 9:30pm after the patient had collapsed.
The fire department arrived first, and initiated CPR. ACD was
applied, and reportedly the patient was shocked x 1 for VFIB
(strip not available).  EMS team arrived at 9:40 PM, pt in
asystole at that time. CPR continued, ACLS started and pt given
epi x 2 and atropine x 1 at which point he developed sinus brady
at 57 and SBP 110/70.  He was intubated in the field and
transported to OSH.
.
The patient's wife reports that the patient had complained of
chest pain during exercise over the past few months. No reports
of pain today. Wife reports he had no recent complaints of
fever/chills at home. No complaints of dyspnea. No significant
PMH with the exception of hyperlipidemia for which he took
medication.
.
At the OSH: Initial Vitals: HR 50-60, BP 100-110/60-70s,
afebrile. WBC: 11, Hct 43.4, Plt 211, Na 138, K 3.5, Cl 100, CO2
17, Glc 272, BUN 31, Cr 1.4, CK 426, MB 3.8, I 0.8, TropI 0.09
(nl 0-0.3).  Started on lidocaine gtt, propofol gtt, given ASA
325 PR, ativan 1 mg IV, 1 L NS.  GCS = 4 per [**Location (un) **] note.
.
[**Location (un) 7622**] to [**Hospital1 18**] CCU at request of family.
.
ROS: Unable to obtain.

MEDICAL HISTORY: Hyperlipidemia
No history of hypertension or diabetes

MEDICATION ON ADMISSION: Unknown medication for high cholesterol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
VS: T 99.8, HR 80 BP 117/75, RR 19, O2 100% on AC 500x20, 60%,
PEEP 5.
Gen: intubated, sedated, nonresponsive.
HEENT: NCAT. Sclera anicteric. PERRL 4->2 b/l. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without JVD
CV: 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, ND, No HSM. No abdominial bruits.
Ext: Cool to touch. No c/c/e. 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: There is no family history of premature coronary artery disease
or sudden death. Father died of MI at age 60s, grandfather age
80s. [**Name2 (NI) **] history of arrhythmia. No recent travel. Pt moved to the
US at age 20.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse or drug use. 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Ventricular fibrillation,Other and unspecified hyperlipidemia,Family history of ischemic heart disease,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Nausea alone,Other and unspecified superficial injury of face, neck, and scalp, without mention of infection,Accidental fall from bed,Accidents occurring in residential institution'}
