CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 71 year old
male with a history of hypertension, diabetes mellitus, and
neurogenic bladder, who presented with light-headedness.  The
patient was in an outside hospital for urinary tract
infection for which he had been prescribed Ciprofloxacin.
Yesterday after dinner, the patient had an episode of
light-headedness after rising from his chair.  The patient
sat down and symptoms resolved within minutes.  No chest
pain, shortness of breath, palpitations, positive for
diaphoresis.  One hour after dinner, the patient stood up
from couch and felt light-headedness.  Again, positive for
diaphoresis, however, no chest pain, shortness of breath,
palpitations.  His symptoms persisted for about one half hour
and the patient called 911.  The patient's blood pressure
prior to EMT arrival was systolic around 80s, pulse around
40s.  In the Emergency Department, the patient was found with
an ectopic atrial rhythm around 40s with systolic blood
pressure of 116.  He states Atropine was given.

MEDICAL HISTORY: 1.  Hypertension.
2.  Type 2 diabetes mellitus.
3.  Neurogenic bladder.
4.  Chronic renal insufficiency.
5.  Status post cholecystectomy.

MEDICATION ON ADMISSION: 1.  Verapamil 240 mg twice a day.
2.  Furosemide 40 mg once daily.
3.  Valsartan 80 mg once daily.
4.  Labetalol 200 mg twice a day.
5.  Insulin NPH 20 units twice a day.
6.  Tamsulosin 0.4 mg once daily.
7.  Bethanechol 25 mg four times a day which was a new drug
for him.
8.  Nitrofurantoin 50 mg twice a day.
9.  Ciprofloxacin 250 mg times five days.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of coronary artery disease or
diabetes mellitus.

SOCIAL HISTORY: The patient lives with wife. [**Name (NI) **] tobacco, no
alcohol and no intravenous drug abuse.
Atrioventricular block, complete,Urinary tract infection, site not specified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Neurogenic bladder NOS,Unspecified disorder of kidney and ureter
Atriovent block complete,Urin tract infection NOS,Cardiac dysrhythmias NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Neurogenic bladder NOS,Renal & ureteral dis NOS
Admission Date:  [**2195-8-21**]       Discharge Date:  [**2195-8-25**]

Date of Birth:   [**2123-12-18**]       Sex:  M

Service:  CCU-MEDICINE

ADMISSION DIAGNOSIS:  Chest pain.

HISTORY OF PRESENT ILLNESS:  The patient is a 71 year old
male with a history of hypertension, diabetes mellitus, and
neurogenic bladder, who presented with light-headedness.  The
patient was in an outside hospital for urinary tract
infection for which he had been prescribed Ciprofloxacin.
Yesterday after dinner, the patient had an episode of
light-headedness after rising from his chair.  The patient
sat down and symptoms resolved within minutes.  No chest
pain, shortness of breath, palpitations, positive for
diaphoresis.  One hour after dinner, the patient stood up
from couch and felt light-headedness.  Again, positive for
diaphoresis, however, no chest pain, shortness of breath,
palpitations.  His symptoms persisted for about one half hour
and the patient called 911.  The patient's blood pressure
prior to EMT arrival was systolic around 80s, pulse around
40s.  In the Emergency Department, the patient was found with
an ectopic atrial rhythm around 40s with systolic blood
pressure of 116.  He states Atropine was given.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Type 2 diabetes mellitus.
3.  Neurogenic bladder.
4.  Chronic renal insufficiency.
5.  Status post cholecystectomy.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Verapamil 240 mg twice a day.
2.  Furosemide 40 mg once daily.
3.  Valsartan 80 mg once daily.
4.  Labetalol 200 mg twice a day.
5.  Insulin NPH 20 units twice a day.
6.  Tamsulosin 0.4 mg once daily.
7.  Bethanechol 25 mg four times a day which was a new drug
for him.
8.  Nitrofurantoin 50 mg twice a day.
9.  Ciprofloxacin 250 mg times five days.

SOCIAL HISTORY:  The patient lives with wife. [**Name (NI) **] tobacco, no
alcohol and no intravenous drug abuse.

FAMILY HISTORY:  No history of coronary artery disease or
diabetes mellitus.

PHYSICAL EXAMINATION:  Vital signs revealed heart rate 54,
sinus, blood pressure 161/79, respiratory rate 20, oxygen
saturation 96% on four liters nasal cannula.  In general, the
patient is pleasant elderly male in no apparent distress,
awake, alert and oriented times three.  Head, eyes, ears,
nose and throat is normocephalic and atraumatic.  The pupils
are equal, round, and reactive to light and accommodation.
Anicteric. The oropharynx is clear.  Neck is supple with no
masses, no jugular venous distention.  Carotids are 2+
bilaterally without bruits.  Cardiovascular reveals
bradycardia but regular, no murmurs, rubs or gallops.  Lungs
are clear to auscultation bilaterally.  Abdomen is soft,
nontender, nondistended, positive bowel sounds.  Extremities
- 1+ pitting edema bilaterally.

LABORATORY DATA:  On admission, CK was 158, CK MB 4.0,
troponin I less than 0.01.  Chem7 and complete blood count
were stable.

Electrocardiogram showed junctional bradycardia at a heart
rate of 45 beats per minute.  Chest x-ray showed widened
mediastinum likely secondary to tortuous aorta.

HOSPITAL COURSE:
1.  Cardiovascular - Symptomatic bradycardia.  The patient's
beta blocker, calcium channel blocker and Bethanechol were
held on admission.  Additionally, electrophysiology was
consulted for his bradycardia and diagnosed with junctional
bradycardia with VA conduction and most likely cause of his
junctional bradycardia was AV nodal disease with His-Purkinje
system disease.  At that time, temporary pacer was placed in
the patient and after 48 hours, the patient was still pacer
dependent.  At that time, a permanent pacemaker was placed
secondary to third degree AV block.  Additionally, the
patient's blood pressure medications were titrated
accordingly.   Finally, the patient was instructed to
discontinue his Bethanechol.

The patient tolerated his pacemaker placement with no
problems and was discharged with electrophysiology follow-up
in addition to medications being Valsartan 80 mg a day,
Labetalol 200 mg three times a day, Verapamil 240 mg twice a
day, Hydralazine 10 mg q6hours and Hydrochlorothiazide 25 mg
a day.

2.  Urinary tract infection - The patient completed a seven
day course of Ciprofloxacin.

3.  Diabetes mellitus - The patient's diabetes mellitus was
controlled with four times a day fingerstick and NPH insulin.
No changes were made to this regimen.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  The patient was discharged to home.

DISCHARGE DIAGNOSES:
1.  AV nodal disease.
2.  Permanent pacemaker implantation.

MEDICATIONS ON DISCHARGE:
1.  Valsartan 80 mg once daily.
2.  Tamsulosin 0.4 mg p.o. q.h.s.
3.  Docusate 100 mg twice a day p.r.n. constipation.
4.  Labetalol 200 mg p.o. three times a day.
5.  Verapamil 240 mg p.o. q12hours.
6.  Hydralazine 10 mg p.o. q6hours.
7.  Hydrochlorothiazide 25 mg p.o. once daily.
8.  Cephalexin 500 mg p.o. q6hours times one day.
9.  NPH 20 units in the a.m. and 20 units in the p.m.

FOLLOW-UP PLANS:  The patient is to follow-up with primary
care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 35256**], for a follow-up appointment in
one to two weeks.

The patient also has an electrophysiology follow-up with Dr.
[**Last Name (STitle) 50355**] on [**2195-9-1**], at 10:00 a.m.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D.  [**MD Number(1) 23649**]

Dictated By:[**Last Name (NamePattern4) 50356**]
MEDQUIST36

D:  [**2195-8-26**]  16:53
T:  [**2195-8-26**]  18:08
JOB#:  [**Job Number 50357**]
{'Atrioventricular block, complete,Urinary tract infection, site not specified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Neurogenic bladder NOS,Unspecified disorder of kidney and ureter'}


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 71 year old
male with a history of hypertension, diabetes mellitus, and
neurogenic bladder, who presented with light-headedness.  The
patient was in an outside hospital for urinary tract
infection for which he had been prescribed Ciprofloxacin.
Yesterday after dinner, the patient had an episode of
light-headedness after rising from his chair.  The patient
sat down and symptoms resolved within minutes.  No chest
pain, shortness of breath, palpitations, positive for
diaphoresis.  One hour after dinner, the patient stood up
from couch and felt light-headedness.  Again, positive for
diaphoresis, however, no chest pain, shortness of breath,
palpitations.  His symptoms persisted for about one half hour
and the patient called 911.  The patient's blood pressure
prior to EMT arrival was systolic around 80s, pulse around
40s.  In the Emergency Department, the patient was found with
an ectopic atrial rhythm around 40s with systolic blood
pressure of 116.  He states Atropine was given.

MEDICAL HISTORY: 1.  Hypertension.
2.  Type 2 diabetes mellitus.
3.  Neurogenic bladder.
4.  Chronic renal insufficiency.
5.  Status post cholecystectomy.

MEDICATION ON ADMISSION: 1.  Verapamil 240 mg twice a day.
2.  Furosemide 40 mg once daily.
3.  Valsartan 80 mg once daily.
4.  Labetalol 200 mg twice a day.
5.  Insulin NPH 20 units twice a day.
6.  Tamsulosin 0.4 mg once daily.
7.  Bethanechol 25 mg four times a day which was a new drug
for him.
8.  Nitrofurantoin 50 mg twice a day.
9.  Ciprofloxacin 250 mg times five days.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of coronary artery disease or
diabetes mellitus.

SOCIAL HISTORY: The patient lives with wife. [**Name (NI) **] tobacco, no
alcohol and no intravenous drug abuse. 

### Response:
{'Atrioventricular block, complete,Urinary tract infection, site not specified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Neurogenic bladder NOS,Unspecified disorder of kidney and ureter'}
