CHIEF COMPLAINT: Vfib Arrest

PRESENT ILLNESS: CCU ADMISSION NOTE
.
cc:[**CC Contact Info 73948**].
HPI: 75 year old man w/hx of AS, CABG x4 in [**2110**], recent PCI
with stenting of RCA and POBA to 80% diagonal [**1-/2118**](Dr.
[**Last Name (STitle) 3302**]presenting as transfer from outside hospital after VF
arrest. The patient had been reporting increasing amounts of
chest pain beginning 2 months after PCI, mostly at night,
thought to be consistent with his known Reflux Disease. He had
been frequently awaking at night with pain, elevating his arms,
turning on his side, and taking both isosorbide dinitrate and
nitroglycerine up to 4 days per week. These measures would
relieve his pain. On the day of his arrest, however, he awoke in
the morning with similar and severe pain ([**9-21**]). It did not
abate throughout the day, despite taking 2.5 mg of isordil x5
and SL NTG x 4 before he arrived at OSH. During his work up, he
had continuing chest pain, received ECG w/o ST changes, then SL
nitroglycerine and then turned pale and lost consciousness. He
was found to be in Vfib arrest, was shocked once with an AED,
then received atropine x 1, lidocaine gtt. Now AAOX3, with
sternal tenderness. No CP as before arrest.
.
He was transfered here for cardiac cath which showed no
significant change from [**2118-1-11**], save for 95% restenosis of
previously POBA'd 80% diag.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
History of Left Bundle Branch Block
CAD, s/p CABG x 4 in [**2110**] (LIMA-LAD, SVG-OM1, SVG-OM2, SVG-dRCA)

MEDICATION ON ADMISSION: Norvasc 2.5', Aspirin 325', Metoprolol 200', HCTZ 12.5',
ASA 81', Niacin 500'', Lisinopril 5', Zocor 20', Isosorbide 10',
Calcium 600 + Vitamin D 400 Units 2 caps', Elegard - last shot
in [**10/2117**], Plavix 75'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.6 BP 160/64, HR 75, RR 15, O2 97% on RA
Gen: elderly man in NAD, resp or otherwise. Oriented x3. Mood,
affect appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. Well hydrated.
Neck: Supple with JVP of 7 cm. Thyroid non-enlarged.
CV: Regular rhythm, S1, S2, III/VI systolic
crescendo-decrescendo murmur heard throughout precordium with
radiation to carotids as well as apex. Sounds lower-pitched at
upper sternal borders, and higher pitched at apex. No gallop or
rub.
Chest: Old sternotomy scar. Resp were unlabored, no accessory
muscle use. Crackles 1/3 up bilaterally.
Abd: Large pannus, soft, NTND. No abdominal bruits. No
organomegaly.
Ext: 1+ LLE edema, trace R ankle edema.
Pulses:
Carotids pulsus parvus e tardus; Femoral 2+ BL; 1+ DP/PT BL

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married with two grown children. He does not
smoke. Heavy drinking x 10 yrs, stopped 4 yrs ago. Exercised
regularly 4 days per week until 1 year ago when limited by pain.
He owns a testing lab for aircraft components.
Subendocardial infarction, initial episode of care,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status
Subendo infarct, initial,Ventricular fibrillation,Crnry athrscl natve vssl,Aortic valve disorder,Esophageal reflux,Hypertension NOS,Hyperlipidemia NEC/NOS,Status-post ptca
Admission Date:  [**2118-6-15**]              Discharge Date:   [**2118-6-26**]

Date of Birth:  [**2042-10-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Vfib Arrest

Major Surgical or Invasive Procedure:
PROCEDURES:
1. Redo coronary bypass grafting times one with reversed
   saphenous vein graft from the aorta to the first
   diagonal coronary artery.
2. Aortic valve replacement with a 27 mm [**Company 1543**] Mosaic
   aortic valve bioprosthesis.


History of Present Illness:
CCU ADMISSION NOTE
.
cc:[**CC Contact Info 73948**].
HPI: 75 year old man w/hx of AS, CABG x4 in [**2110**], recent PCI
with stenting of RCA and POBA to 80% diagonal [**1-/2118**](Dr.
[**Last Name (STitle) 3302**]presenting as transfer from outside hospital after VF
arrest. The patient had been reporting increasing amounts of
chest pain beginning 2 months after PCI, mostly at night,
thought to be consistent with his known Reflux Disease. He had
been frequently awaking at night with pain, elevating his arms,
turning on his side, and taking both isosorbide dinitrate and
nitroglycerine up to 4 days per week. These measures would
relieve his pain. On the day of his arrest, however, he awoke in
the morning with similar and severe pain ([**9-21**]). It did not
abate throughout the day, despite taking 2.5 mg of isordil x5
and SL NTG x 4 before he arrived at OSH. During his work up, he
had continuing chest pain, received ECG w/o ST changes, then SL
nitroglycerine and then turned pale and lost consciousness. He
was found to be in Vfib arrest, was shocked once with an AED,
then received atropine x 1, lidocaine gtt. Now AAOX3, with
sternal tenderness. No CP as before arrest.
.
He was transfered here for cardiac cath which showed no
significant change from [**2118-1-11**], save for 95% restenosis of
previously POBA'd 80% diag.


Past Medical History:
Hypertension
Hyperlipidemia
History of Left Bundle Branch Block
CAD, s/p CABG x 4 in [**2110**] (LIMA-LAD, SVG-OM1, SVG-OM2, SVG-dRCA)

CAD s/p PCI [**1-/2118**] with BMS Stenting to RCA and POBA to 80%
Diag.
Aortic Stenosis
h/o Cholecystitis
Hernia repair [**2117-8-15**]
Prostate ca s/p hormone shots
Reports "hole in stomach" that was going to be repaired by Dr.
[**Last Name (STitle) **] within the past year, but was held given risks from CAD



Social History:
Married with two grown children. He does not
smoke. Heavy drinking x 10 yrs, stopped 4 yrs ago. Exercised
regularly 4 days per week until 1 year ago when limited by pain.
He owns a testing lab for aircraft components.


Family History:
non-contributory

Physical Exam:
VS: T 98.6 BP 160/64, HR 75, RR 15, O2 97% on RA
Gen: elderly man in NAD, resp or otherwise. Oriented x3. Mood,
affect appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. Well hydrated.
Neck: Supple with JVP of 7 cm. Thyroid non-enlarged.
CV: Regular rhythm, S1, S2, III/VI systolic
crescendo-decrescendo murmur heard throughout precordium with
radiation to carotids as well as apex. Sounds lower-pitched at
upper sternal borders, and higher pitched at apex. No gallop or
rub.
Chest: Old sternotomy scar. Resp were unlabored, no accessory
muscle use. Crackles 1/3 up bilaterally.
Abd: Large pannus, soft, NTND. No abdominal bruits. No
organomegaly.
Ext: 1+ LLE edema, trace R ankle edema.
Pulses:
Carotids pulsus parvus e tardus; Femoral 2+ BL; 1+ DP/PT BL


Pertinent Results:
[**2118-6-26**] 07:05AM BLOOD

Hct-23.0*

[**2118-6-22**] 06:13PM BLOOD

PT-15.1* PTT-61.0* INR(PT)-1.3

[**2118-6-25**] 07:20AM BLOOD

 WBC-7.3 RBC-2.72* Hgb-8.5* Hct-24.1* MCV-89 MCH-31.3 MCHC-35.2*
RDW-16.6* Plt Ct-115*

[**2118-6-25**] 07:20AM BLOOD

Glucose-123* UreaN-15 Creat-0.6 Na-139 K-3.7 Cl-102 HCO3-29
AnGap-12

[**2118-6-24**] 03:00AM BLOOD

Calcium-8.0* Phos-3.5 Mg-2.5

[**2118-6-21**] 03:38PM

URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.012
URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG
Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG

[**2118-6-21**] 3:38 pm URINE      Source: CVS.
URINE CULTURE (Final [**2118-6-22**]):    NO GROWTH.

[**2118-6-25**] 7:42 AM

CHEST (PORTABLE AP)

CHEST

Cardiac size is enlarged. There is collapse consolidation in the
left lower lobe with loss of the left hemidiaphragm. No evidence
of a pneumothorax is seen. The right lung is clear. There is no
failure.

IMPRESSION: No pneumothorax, left lower lobe collapse
consolidation

Brief Hospital Course:
[**6-15**] Vfib Arrest/Rhythm: Unclear what precipitant was. Cath was
without an obvious clot or plaque rupture that would be
responsible for his arrest. With his known valvular disease, it
is possible that his preload was droppped enough with multiple
nitroglycerine administration to cause global coronary ischemia
and his Vfib. He was alert and oriented post-arrest.

Admitted to the CCU

Cardiology consult

[**6-16**] - [**6-22**] awaitng plavix washout, Cardiac echo / carotid US /
dental consult obtained for prep for surgery, IV hep for afib /
thrombus PPX

Coronary Artery Disease: diffuse three vessel disease without
significant change on cath from previously. Does have 95%
re-stenosis of previously angioplastied diagonal, but this is
doubtful as cause of his arrest or ongoing anginal/gerd
symptoms. His symptoms prior to arrest do sound very much like
Reflux disease, but there is likely some angina as well.
Screening CXR, carotid US and vein mapping completed. Plavix
washout and CT surgery [**6-22**].
-Type and Cross 4U pre-op
-Continue ASA, statin, lisinopril and metoprolol

[**6-22**]

PROCEDURES:
1. Redo coronary bypass grafting times one with reversed
    saphenous vein graft from the aorta to the first
    diagonal coronary artery.
2. Aortic valve replacement with a 27 mm [**Company 1543**] Mosaic
    aortic valve bioprosthesis.

Extubated without complicaton

[**6-23**] pt HCT 21 / transfused 2 units PRBC's
     epi drip for blood pressure support
     asa, plavix, BB, statin started
     peri op vanco
     insulin drip
     diuresis post operative
     adat

[**6-24**] epi weaned off
     BB increased / hydralazine DC'd
     anemia stable
     ct / aline / cordis [**Hospital 1788**]
     transfer to regular floor
     diuresis continued
     tolerating diet

[**6-25**] foley DC'd / urinating
     epicardial wires dc's
     pt consult

[**6-26**] stable for dc



Medications on Admission:
Norvasc 2.5', Aspirin 325', Metoprolol 200', HCTZ 12.5',
ASA 81', Niacin 500'', Lisinopril 5', Zocor 20', Isosorbide 10',
Calcium 600 + Vitamin D 400 Units 2 caps', Elegard - last shot
in [**10/2117**], Plavix 75'


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
3. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 7 days.
Disp:*14 Packet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. 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*
7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Niacin 500 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO BID (2 times a day).
Disp:*60 Capsule, Sustained Release(s)* Refills:*2*
9. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Ferrous Gluconate 325 mg (37.5 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
12. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*1*
13. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
14. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
15. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
Disp:*30 Suppository(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 2436**] Home Care

Discharge Diagnosis:
1. Recurrent coronary artery disease, status post recent
   non-Q-wave myocardial infarction;  status post previous
   coronary artery bypass grafting with patent grafts.
2. Aortic stenosis.


Discharge Condition:
Good


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower daily, no baths, no lotions, creams or powders to
incisions.
No lifting more than 10 pounds for 10 weeks.
No driving until follow up with surgeon OR at least 4 weeks.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 177**] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 170**]  Follow-up appointment
should be in 1 month

Provider: [**Name10 (NameIs) 73949**],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 73950**]  Follow-up appointment
should be in 2 weeks

Provider: [**Name10 (NameIs) 2085**]  [**Name11 (NameIs) **] appointment should be in 2
weeks



Completed by:[**2118-6-26**]
{'Subendocardial infarction, initial episode of care,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,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: Vfib Arrest

PRESENT ILLNESS: CCU ADMISSION NOTE
.
cc:[**CC Contact Info 73948**].
HPI: 75 year old man w/hx of AS, CABG x4 in [**2110**], recent PCI
with stenting of RCA and POBA to 80% diagonal [**1-/2118**](Dr.
[**Last Name (STitle) 3302**]presenting as transfer from outside hospital after VF
arrest. The patient had been reporting increasing amounts of
chest pain beginning 2 months after PCI, mostly at night,
thought to be consistent with his known Reflux Disease. He had
been frequently awaking at night with pain, elevating his arms,
turning on his side, and taking both isosorbide dinitrate and
nitroglycerine up to 4 days per week. These measures would
relieve his pain. On the day of his arrest, however, he awoke in
the morning with similar and severe pain ([**9-21**]). It did not
abate throughout the day, despite taking 2.5 mg of isordil x5
and SL NTG x 4 before he arrived at OSH. During his work up, he
had continuing chest pain, received ECG w/o ST changes, then SL
nitroglycerine and then turned pale and lost consciousness. He
was found to be in Vfib arrest, was shocked once with an AED,
then received atropine x 1, lidocaine gtt. Now AAOX3, with
sternal tenderness. No CP as before arrest.
.
He was transfered here for cardiac cath which showed no
significant change from [**2118-1-11**], save for 95% restenosis of
previously POBA'd 80% diag.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
History of Left Bundle Branch Block
CAD, s/p CABG x 4 in [**2110**] (LIMA-LAD, SVG-OM1, SVG-OM2, SVG-dRCA)

MEDICATION ON ADMISSION: Norvasc 2.5', Aspirin 325', Metoprolol 200', HCTZ 12.5',
ASA 81', Niacin 500'', Lisinopril 5', Zocor 20', Isosorbide 10',
Calcium 600 + Vitamin D 400 Units 2 caps', Elegard - last shot
in [**10/2117**], Plavix 75'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.6 BP 160/64, HR 75, RR 15, O2 97% on RA
Gen: elderly man in NAD, resp or otherwise. Oriented x3. Mood,
affect appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. Well hydrated.
Neck: Supple with JVP of 7 cm. Thyroid non-enlarged.
CV: Regular rhythm, S1, S2, III/VI systolic
crescendo-decrescendo murmur heard throughout precordium with
radiation to carotids as well as apex. Sounds lower-pitched at
upper sternal borders, and higher pitched at apex. No gallop or
rub.
Chest: Old sternotomy scar. Resp were unlabored, no accessory
muscle use. Crackles 1/3 up bilaterally.
Abd: Large pannus, soft, NTND. No abdominal bruits. No
organomegaly.
Ext: 1+ LLE edema, trace R ankle edema.
Pulses:
Carotids pulsus parvus e tardus; Femoral 2+ BL; 1+ DP/PT BL

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married with two grown children. He does not
smoke. Heavy drinking x 10 yrs, stopped 4 yrs ago. Exercised
regularly 4 days per week until 1 year ago when limited by pain.
He owns a testing lab for aircraft components. 

### Response:
{'Subendocardial infarction, initial episode of care,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status'}
