CHIEF COMPLAINT: Irregular Heart Rhythm

PRESENT ILLNESS: Mr. [**Known lastname **] is a 57 year-old Mandarin-speaking man recently diagnosed
with unresectable cholangiocarcinoma who presents with
tachycardia.  Due to language barrier, history is obtained
mainly from the records and his son.  Pt was diagnosed with
unresectable cholangiocarcinoma in [**October 2187**].  Per his son,
the patient had been doing well since being discharged from the
hospital on [**11-23**], including being able to walk on the tred
mill.  On the day of admission, he came in for a scheduled CT
scan for staging.  He began to notice increased PO intake
afterwards due to abdominal discomfort.  Around 7pm complained
of not feeling well, generalized myalgias. He was brought into
the ED by family for further evaluation.
.
In the emergency department, his initial vitals were T 95.4, BP
80/62, HR 165, RR 35, 92% on RA to 98% on 4L.  ECG was
interpreted as sinus tachycardia.  He received 3L IVF with
improvement of BP to 90-100s.  HR decreased to 140s.  Exam was
otherwise unremarkable per report.  Out of concern for PE, head
CT was performed to rule out brain mets (negative), and he was
guaiac negative.  Heparin gtt was initiated.  He was also given
aspirin.  Received vanco/zosyn on arrival in setting of
hypotension.  Given persistently elevated HR, he was admitted to
the [**Hospital Unit Name 153**] for further management.
.
On arrival to the floor, he appears tired but comfortable.  HR
initially in the 140s with SBP in the 100s.  ECG consistent with
a supraventricular tachycardia.  Received lopressor 5mg IV x 2
and converted to sinus with HR in the 80s and BP in the
100-110s.  Later in the morning he converted back into the
narrow complex tachycardia but remains asymptomatic with stable
BP.

MEDICAL HISTORY: -Cholangiocarcinoma, dx [**2187-10-25**], s/p bilateral metallic biliary
stent placement on [**2187-11-22**] (removed on [**11-23**]), known extension
into the liver, pancreas, duodenum, common bile duct and
there appeared to be extensive involvement of the main common
hepatic artery, proper hepatic artery as well as encasement of
the portal vein; it is not surgically resectable; plan is for
palliative chemo but has not yet started treatment
-Hypertension

MEDICATION ON ADMISSION: Amlodipine 10mg PO daily
Metoprolol XL 50mg PO daily
Dilaudid 2mg PO q4 prn
Lorazepam 1mg qHS prn
Colace 100mg PO BID prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: Pleasant, sleepy but arousable and appears comfortable,
in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD.
CARDIAC: Regular rhythm, tachycardic. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP at clavicle.
LUNGS: CTAB, good air movement biaterally, no wheeze or rales.
ABDOMEN: Well-healing ex-lap scar, NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 1+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact.
PSYCH: Listens and responds to questions appropriately, pleasant

FAMILY HISTORY: No history of GI cancer

SOCIAL HISTORY: He works in a restaurant. He moved to the USA 20 years ago but
he speaks minimal English. He is married with 5 kids, the oldest
33 years old. His wife does not speak english but his children
do.  He smoked 1 pack for many years but quit 20 years ago.
Other specified cardiac dysrhythmias,Malignant neoplasm of intrahepatic bile ducts,Malignant neoplasm of liver, secondary,Unspecified essential hypertension
Cardiac dysrhythmias NEC,Mal neo intrahepat ducts,Second malig neo liver,Hypertension NOS
Admission Date:  [**2187-12-7**]              Discharge Date:   [**2187-12-8**]

Date of Birth:  [**2130-9-14**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5893**]
Chief Complaint:
Irregular Heart Rhythm

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname **] is a 57 year-old Mandarin-speaking man recently diagnosed
with unresectable cholangiocarcinoma who presents with
tachycardia.  Due to language barrier, history is obtained
mainly from the records and his son.  Pt was diagnosed with
unresectable cholangiocarcinoma in [**October 2187**].  Per his son,
the patient had been doing well since being discharged from the
hospital on [**11-23**], including being able to walk on the tred
mill.  On the day of admission, he came in for a scheduled CT
scan for staging.  He began to notice increased PO intake
afterwards due to abdominal discomfort.  Around 7pm complained
of not feeling well, generalized myalgias. He was brought into
the ED by family for further evaluation.
.
In the emergency department, his initial vitals were T 95.4, BP
80/62, HR 165, RR 35, 92% on RA to 98% on 4L.  ECG was
interpreted as sinus tachycardia.  He received 3L IVF with
improvement of BP to 90-100s.  HR decreased to 140s.  Exam was
otherwise unremarkable per report.  Out of concern for PE, head
CT was performed to rule out brain mets (negative), and he was
guaiac negative.  Heparin gtt was initiated.  He was also given
aspirin.  Received vanco/zosyn on arrival in setting of
hypotension.  Given persistently elevated HR, he was admitted to
the [**Hospital Unit Name 153**] for further management.
.
On arrival to the floor, he appears tired but comfortable.  HR
initially in the 140s with SBP in the 100s.  ECG consistent with
a supraventricular tachycardia.  Received lopressor 5mg IV x 2
and converted to sinus with HR in the 80s and BP in the
100-110s.  Later in the morning he converted back into the
narrow complex tachycardia but remains asymptomatic with stable
BP.

Past Medical History:
-Cholangiocarcinoma, dx [**2187-10-25**], s/p bilateral metallic biliary
stent placement on [**2187-11-22**] (removed on [**11-23**]), known extension
into the liver, pancreas, duodenum, common bile duct and
there appeared to be extensive involvement of the main common
hepatic artery, proper hepatic artery as well as encasement of
the portal vein; it is not surgically resectable; plan is for
palliative chemo but has not yet started treatment
-Hypertension

Social History:
He works in a restaurant. He moved to the USA 20 years ago but
he speaks minimal English. He is married with 5 kids, the oldest
33 years old. His wife does not speak english but his children
do.  He smoked 1 pack for many years but quit 20 years ago.

Family History:
No history of GI cancer

Physical Exam:
GENERAL: Pleasant, sleepy but arousable and appears comfortable,
in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD.
CARDIAC: Regular rhythm, tachycardic. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP at clavicle.
LUNGS: CTAB, good air movement biaterally, no wheeze or rales.
ABDOMEN: Well-healing ex-lap scar, NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 1+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact.
PSYCH: Listens and responds to questions appropriately, pleasant

Pertinent Results:
[**2187-12-6**] 11:55PM   GLUCOSE-130* UREA N-13 CREAT-0.9 SODIUM-133
POTASSIUM-3.8 CHLORIDE-96 TOTAL CO2-23 ANION GAP-18
[**2187-12-6**] 11:58PM   LACTATE-2.5*
[**2187-12-6**] 11:55PM   ALT(SGPT)-34 AST(SGOT)-33 CK(CPK)-60 ALK
PHOS-170* TOT BILI-1.0
[**2187-12-6**] 11:55PM   WBC-13.7* RBC-4.20* HGB-13.0* HCT-38.0*
MCV-90 MCH-31.0 MCHC-34.2 RDW-14.6
[**2187-12-6**] 11:55PM   NEUTS-64.6 LYMPHS-27.6 MONOS-5.4 EOS-1.7
BASOS-0.7
[**2187-12-6**] 11:55PM   PT-12.0 PTT-21.4* INR(PT)-1.0

CT Head:
FINDINGS: There is no evidence of hemorrhage, edema, masses,
mass effect, or acute infarction. The [**Doctor Last Name 352**]-white matter
differentiation is preserved. The ventricles and sulci are
normal in caliber and configuration. No acute
fracture. Visualized portions of paranasal sinuses and mastoid
air cells are well aerated.

IMPRESSION: No evidence of intracranial mass effect to suggest
underlying
mass. Note that CT has limited sensitivity for detection of
metastasis and MR can be obtained as clinically indicated.

ADDENDUM AT ATTENDING REVIEW: There are multiple subcm. regions
of low density in the basal ganglia regions bilaterally, as well
as the head of the right caudate nucleus. No overt mass effect
is seen from these admittedly small lesions. Most likely, they
represent small vessel infarcts, subacute to chronic in age, but
as noted above, MRI would help to confirm or refute this
diagnosis. Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] calling the housetaff to inform them of
this amended finding, and also to inquire as to whether there
are any known vascular disease risk factors that may predispose
this patient to infarction.  There is mild atherosclerotic
calcification of the distal right vertebral artery, and to a
minimal degree, the distal left vertebral artery, both at the
level of the foramen magnum as well as the cavernous internal
carotid arteries.

Brief Hospital Course:
ASSESSMENT AND PLAN:  57 year-old man with newly diagnosed
metastatic cholangiocarcinoma admitted with tachycardia and
hypotension, found to be in AVNRT.

#  Tachycardia:  On arrival, patient was found to have a narrow
complex regular tachycardia; EP consult confirmed AVNRT.
Patient was treated with carotid massage and metoprolol IV with
good effect.  There was originally concern for PE in setting of
malignancy; a head CT was done (initial read showing no mets)
and patient was guiac negative so a heparin ggt was started.
However, upon transfer to the ICU, diagnosis of PE was deemed
unlikely and heparin ggt was stopped.  In the [**Hospital Unit Name 153**], Mr. [**Known lastname **] was
started on PO metoprolol, and he remained in sinus rhythm.  He
was hemodynamically stable and feeling well upon discharge.  He
will need a TTE as an outpatient, and can make an appointment
upon discharge.
.
#  Hypotension:  Mr. [**Known lastname **] was initially hypotensive in the setting
of HR up to the 160s.  BP improved with IVF and normalization of
heart rate.  Anti-hypertensive medications (amlodipine) were
held initially.  Upon discharge, BP had come up to 140/100, and
home anti-hypertensives were restarted.
.
#  Leukocytosis:  In the setting of previous hypotension and
hypothermia, there was initial concern for infection.  However,
there was no left shift or localizing signs of infection, and
WBC count went down to 8.4 on second hospital day.  We continued
to monitor WBC and fever curve and held off on antibiotics as
patient was clinically stable.  Blood cultures were pending upon
discharge and urine culture showed no growth.

#  Cholangiocarcinoma:  He is scheduled to be seen at [**Hospital 10596**] on [**12-10**] for a second opinion.  Oncology consult team saw
patient during hospital stay.  We were in close contact with
patient's outpatient oncology team Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **]
throughout admission.
.
#  Hypertension:  On amlodipine and toprol XL as outpatient.
Amlodipine was held during admission and toprol XL was switched
to metoprolol [**Hospital1 **].  Amlodipine and Toprol were reinstated upon
discharge.
.
Patient was put on bowel regimen and given subcu heparin for DVT
prophylaxis.  He is full code.  Team with in close contact with
patient's son during admission.

Medications on Admission:
Amlodipine 10mg PO daily
Metoprolol XL 50mg PO daily
Dilaudid 2mg PO q4 prn
Lorazepam 1mg qHS prn
Colace 100mg PO BID prn

Discharge Medications:
1. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Tablet Sustained Release 24 hr(s)
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
3. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for pain.
5. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.

Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis: Supraventricular tachycardia
Secondary diagnoses: Cholangiocarcinoma, hypertension.


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

Discharge Instructions:
You were admitted because you were feeling unwell while your
heart was beating very fast.  Your heartrate improved to normal
with medication and your symptoms improved, so you are now ready
to go home.  No changes were made to your medications.

Please take all of your medications as prescribed.  Do not drive
or drink alcohol while taking some of these medications until
you know how they will affect you.

Please keep all of your scheduled follow-up appointments.
Please make sure to make an appointment for an echocardiogram as
an outpatient by calling: [**Telephone/Fax (1) 62**].

Please call your doctor or come back to the hospital if you have
chest pain, difficulty breathing, palpitations, weakness on one
side of your body, slurred speech, severe headache, fever,
chills, nausea/vomiting/diarrhea, or other worrisome symptoms.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern5) 21185**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2187-12-19**] 1:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 28268**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2187-12-19**] 1:30
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4425**], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2187-12-19**]
2:00
.
Please call your primary care doctor, Dr. [**Last Name (STitle) 84320**], at
[**Telephone/Fax (1) 84319**] to make a follow-up visit within 2-3 weeks of you
leaving the hospital.
{'Other specified cardiac dysrhythmias,Malignant neoplasm of intrahepatic bile ducts,Malignant neoplasm of liver, secondary,Unspecified essential hypertension'}


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: Irregular Heart Rhythm

PRESENT ILLNESS: Mr. [**Known lastname **] is a 57 year-old Mandarin-speaking man recently diagnosed
with unresectable cholangiocarcinoma who presents with
tachycardia.  Due to language barrier, history is obtained
mainly from the records and his son.  Pt was diagnosed with
unresectable cholangiocarcinoma in [**October 2187**].  Per his son,
the patient had been doing well since being discharged from the
hospital on [**11-23**], including being able to walk on the tred
mill.  On the day of admission, he came in for a scheduled CT
scan for staging.  He began to notice increased PO intake
afterwards due to abdominal discomfort.  Around 7pm complained
of not feeling well, generalized myalgias. He was brought into
the ED by family for further evaluation.
.
In the emergency department, his initial vitals were T 95.4, BP
80/62, HR 165, RR 35, 92% on RA to 98% on 4L.  ECG was
interpreted as sinus tachycardia.  He received 3L IVF with
improvement of BP to 90-100s.  HR decreased to 140s.  Exam was
otherwise unremarkable per report.  Out of concern for PE, head
CT was performed to rule out brain mets (negative), and he was
guaiac negative.  Heparin gtt was initiated.  He was also given
aspirin.  Received vanco/zosyn on arrival in setting of
hypotension.  Given persistently elevated HR, he was admitted to
the [**Hospital Unit Name 153**] for further management.
.
On arrival to the floor, he appears tired but comfortable.  HR
initially in the 140s with SBP in the 100s.  ECG consistent with
a supraventricular tachycardia.  Received lopressor 5mg IV x 2
and converted to sinus with HR in the 80s and BP in the
100-110s.  Later in the morning he converted back into the
narrow complex tachycardia but remains asymptomatic with stable
BP.

MEDICAL HISTORY: -Cholangiocarcinoma, dx [**2187-10-25**], s/p bilateral metallic biliary
stent placement on [**2187-11-22**] (removed on [**11-23**]), known extension
into the liver, pancreas, duodenum, common bile duct and
there appeared to be extensive involvement of the main common
hepatic artery, proper hepatic artery as well as encasement of
the portal vein; it is not surgically resectable; plan is for
palliative chemo but has not yet started treatment
-Hypertension

MEDICATION ON ADMISSION: Amlodipine 10mg PO daily
Metoprolol XL 50mg PO daily
Dilaudid 2mg PO q4 prn
Lorazepam 1mg qHS prn
Colace 100mg PO BID prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: Pleasant, sleepy but arousable and appears comfortable,
in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD.
CARDIAC: Regular rhythm, tachycardic. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP at clavicle.
LUNGS: CTAB, good air movement biaterally, no wheeze or rales.
ABDOMEN: Well-healing ex-lap scar, NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 1+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact.
PSYCH: Listens and responds to questions appropriately, pleasant

FAMILY HISTORY: No history of GI cancer

SOCIAL HISTORY: He works in a restaurant. He moved to the USA 20 years ago but
he speaks minimal English. He is married with 5 kids, the oldest
33 years old. His wife does not speak english but his children
do.  He smoked 1 pack for many years but quit 20 years ago. 

### Response:
{'Other specified cardiac dysrhythmias,Malignant neoplasm of intrahepatic bile ducts,Malignant neoplasm of liver, secondary,Unspecified essential hypertension'}
