CHIEF COMPLAINT: ICD shocks

PRESENT ILLNESS: 60-year-old man with history of severe dilated cardiomyopathy
(EF 10-15%, non-ischemic, likely familial) status post ICD
implantation with a biventricular upgrade in [**12/2145**], amiodarone
induced pneumonitis, multiple DVTs, chronic atrial fibrillation,
HTN, HLD, DM2, who had a shock from his ICD on [**2146-12-7**] and
then another shock yesterday and a 3rd shock this AM. Prior to
this week, pt's last shock was in [**2146-3-28**]. Pt saw his EP
cardiologist, Dr. [**Last Name (STitle) 11649**], on [**2146-12-7**] after his shock,
who found that he had episode of V. fib and reccomended to
continue current medical management. During that particular
episode, pt reports that he felt dizzy, saw blackness, then was
shocked, and felt like he was in a daze a few minutes later.
Pt has had 3 shocks in the last 4 days. EP interrogated pacer
and found that pt was in V. fib each time.
He reported to OSH where vitals: T 97.7, HR 80, BP 98/58, RR 18,
94-96% RA. Trop 0.64. He had negative CXR. K+=3.5 and his L was
repleted. He was then transfered to [**Hospital1 18**].
In [**Hospital1 18**] ED: Vitals: T 98.5, HR 100, BP 107/76, RR 18, 95% RA.
EP saw pt and reported that he had 3 episodes of V fib last few
3 days. EKG in NSR no ST changes.
.
On review of systems, Denies chest pain, no SOB, no abd pain,
did have a mild headache that has resolved. Remainder of ROS
neg.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes (from steroids for
pneumonitis), +Dyslipidemia, +Hypertension
2. CARDIAC HISTORY:
history of an acute myocardial infarction due to a small embolic
event in [**5-/2145**] without any further intervention
3. OTHER PAST MEDICAL HISTORY:
- Dyslipidemia
- Hypertension
- Coronary Artery Disease - denied per family
- dilated cardiomyopathy, severely depressed EF (10-15%), s/p
ICD
[**2141**] for primary prevention
- Afib treated with digoxin
- polymorphic VT after dofetilide
- Amiodarone-induced hypersensitivity pneumonitis
- Diabetes, diagnosed after being on steroids for pneumonitis
- GI bleed on Coumadin [**2137**] possibly related to ischemic colitis

MEDICATION ON ADMISSION: 1. Aspirin 81 mg Tablet
2. Fondaparinux 7.5 mg/0.6 mL Syringe Sig: One (1) injection
Subcutaneous QHS (once a day (at bedtime)).
3. Escitalopram 10 mg daily
4. Methylprednisolone 5 mg per day
5. Omeprazole 40 mg Capsule, [**Hospital1 **]
6. Metoprolol Tartrate 200mg PO BID
7. Simvastatin 40 mg Tablet daily
8. Xopinex 0.63mg/3cc every 3 rs as needed for wheexing, SOB
9. Spironolactone 12.5 mg PO daily
10. Captopril 25 mg [**Hospital1 **]
11. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
12. Seroquel 100mg/day qhs
13. Digoxin 0.125-mg alternating with 0.25-mg/day HOLD on this
admission. takes at home.
16. Vit D 1,000 U daily
17. Lantus 100 unit/mL Solution Sig: Eight (8) units
Subcutaneous once a day.
18. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
19. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime.
20. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1)
Tablet PO every 6-8 hours as needed for pain: please LIMIT as
much as possible.
21. Ropinirole 0.5mg qhs HOLD - concern for confusion in the
past?
22. Lasix 100mg [**Hospital1 **]

ALLERGIES: Amiodarone

PHYSICAL EXAM: Admission Exam
VS: afebrile, BP= 124/82, HR=82, O2 sat= 97% on 2L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: There is family history of premature coronary artery disease in

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
Ventricular fibrillation,Fitting and adjustment of automatic implantable cardiac defibrillator,Other primary cardiomyopathies,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Old myocardial infarction,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Postinflammatory pulmonary fibrosis,Cardiac rhythm regulators causing adverse effects in therapeutic use,Long-term (current) use of insulin,Personal history of venous thrombosis and embolism,Personal history of tobacco use
Ventricular fibrillation,Ftng autmtc dfibrillator,Prim cardiomyopathy NEC,Sec DM wo cmp nt st uncn,Adv eff corticosteroids,Old myocardial infarct,Hypertension NOS,Obstructive sleep apnea,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Postinflam pulm fibrosis,Adv eff card rhyth regul,Long-term use of insulin,Hx-ven thrombosis/embols,History of tobacco use
Admission Date:  [**2146-12-10**]              Discharge Date:   [**2146-12-13**]

Date of Birth:  [**2086-7-2**]             Sex:   M

Service: MEDICINE

Allergies:
Amiodarone

Attending:[**Doctor First Name 1402**]
Chief Complaint:
ICD shocks

Major Surgical or Invasive Procedure:
None


History of Present Illness:
60-year-old man with history of severe dilated cardiomyopathy
(EF 10-15%, non-ischemic, likely familial) status post ICD
implantation with a biventricular upgrade in [**12/2145**], amiodarone
induced pneumonitis, multiple DVTs, chronic atrial fibrillation,
HTN, HLD, DM2, who had a shock from his ICD on [**2146-12-7**] and
then another shock yesterday and a 3rd shock this AM. Prior to
this week, pt's last shock was in [**2146-3-28**]. Pt saw his EP
cardiologist, Dr. [**Last Name (STitle) 11649**], on [**2146-12-7**] after his shock,
who found that he had episode of V. fib and reccomended to
continue current medical management. During that particular
episode, pt reports that he felt dizzy, saw blackness, then was
shocked, and felt like he was in a daze a few minutes later.
Pt has had 3 shocks in the last 4 days. EP interrogated pacer
and found that pt was in V. fib each time.
He reported to OSH where vitals: T 97.7, HR 80, BP 98/58, RR 18,
94-96% RA. Trop 0.64. He had negative CXR. K+=3.5 and his L was
repleted. He was then transfered to [**Hospital1 18**].
In [**Hospital1 18**] ED: Vitals: T 98.5, HR 100, BP 107/76, RR 18, 95% RA.
EP saw pt and reported that he had 3 episodes of V fib last few
3 days. EKG in NSR no ST changes.
.
On review of systems, Denies chest pain, no SOB, no abd pain,
did have a mild headache that has resolved. Remainder of ROS
neg.


Past Medical History:
1. CARDIAC RISK FACTORS: +Diabetes (from steroids for
pneumonitis), +Dyslipidemia, +Hypertension
2. CARDIAC HISTORY:
history of an acute myocardial infarction due to a small embolic
event in [**5-/2145**] without any further intervention
3. OTHER PAST MEDICAL HISTORY:
- Dyslipidemia
- Hypertension
- Coronary Artery Disease - denied per family
- dilated cardiomyopathy, severely depressed EF (10-15%), s/p
ICD
[**2141**] for primary prevention
- Afib treated with digoxin
- polymorphic VT after dofetilide
- Amiodarone-induced hypersensitivity pneumonitis
- Diabetes, diagnosed after being on steroids for pneumonitis
- GI bleed on Coumadin [**2137**] possibly related to ischemic colitis

- OSA, not on CPAP
- multiple previous DVTs including DVT and PE in [**2126**] following

an ankle trauma, and second episode of PE in [**2137**]. IVC filter
placed [**2137**]. Also had a right brachial vein DVT in [**2139**].
.
PAST SURGICAL HISTORY
- lap cholecystectomy [**2-/2144**]
- IVC filter placement [**2137**]
- bilateral cataract surgery with residual right ptosis
.


Social History:
Social history is significant for the absence of current tobacco

use. Quit smoking 7 years ago after smoking for 40 years x 2ppd.

He drinks no etoh. Lives with wife. Worked at chemical plant
making latex.


Family History:
There is family history of premature coronary artery disease in

patient's father, who had first MI at age 37. Mother also has
dilated cardiomyopathy. Sister had ?[**Name2 (NI) 41267**] CMY (1 episode of
heart failure when very emotional and sad)


Physical Exam:
Admission Exam
VS: afebrile, BP= 124/82, HR=82, O2 sat= 97% on 2L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 8 cm.
CARDIAC: RRR, 1/6 systolic murmur left sternal border
LUNGS: CTAB, slightly decreased breath sounds on right lower
base, no crackles, no rhonchi, no rhales
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: petechia and some mild bruising on bilateral forearms
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
[**2146-12-10**] 02:35PM   cTropnT-0.06*
[**2146-12-10**] 02:35PM   CK(CPK)-59

Brief Hospital Course:
60 M with severe dilated CMY s/p ICD who is admitted for repeat
ICD shocks.
.
# RHYTHM: In V.Fib during th last 3 shocks on [**2146-12-7**], [**11-29**]
and [**12-10**]. Pt has history of VT and VF in setting of severely
dilated CMY. Pt has tried amiodarone in the past that caused
pneumonitis, has been on steroids since. He has also tried
dofetilide- resulted in polymorphic VT side effect.  Pacer was
interrogated and pt found to have been in V. fib when his ICD
went off the last 3 times. Digitalis and seroquel were stopped.
Pt started on Quinidine and had no further episodes in-house. He
will follow up with Dr. [**Last Name (STitle) 1911**] regarding atrial lead. He
has appt scheduled in few weeks.
.
# CORONARIES: Has history of MI in [**5-/2146**] [**3-1**] thromboembolic
event that resolved in its own (has had numerous clots in legs,
arm, coronary, lungs). Troponin I elevated at OSH (0.64) but
might be [**3-1**] defibrillation. Upon transfer to this hospital,
trop T 0.06 x2. No signs of ischemia.
.
# PUMP: Severely dilated CMY with EF 10%-15%. Thought to be
familial since mother has similar condition. Stopped digitalis
on this admission. Started Quinidine. Continued: Captopril,
Spironolactone, metoprolol, ASA, lasix.
.
# Pneumonitis- secondary to amiodarone use in the past.
Continued his medrol 5mg daily.
.
# DM2- home Lantus 8 U daily and ISS
.
# Psych: Continued home meds (remeron and escitalopram) but
discontinued seroquel on admission since it is know to cause QT
prolongation. Ropinirole was also discontinued since it was held
on last admission due to confusion. Pt told to stop both
seroquel and ropinirole.


Medications on Admission:
1. Aspirin 81 mg Tablet
2. Fondaparinux 7.5 mg/0.6 mL Syringe Sig: One (1) injection
Subcutaneous QHS (once a day (at bedtime)).
3. Escitalopram 10 mg daily
4. Methylprednisolone 5 mg per day
5. Omeprazole 40 mg Capsule, [**Hospital1 **]
6. Metoprolol Tartrate 200mg PO BID
7. Simvastatin 40 mg Tablet daily
8. Xopinex 0.63mg/3cc every 3 rs as needed for wheexing, SOB
9. Spironolactone 12.5 mg PO daily
10. Captopril 25 mg [**Hospital1 **]
11. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
12. Seroquel 100mg/day qhs
13. Digoxin 0.125-mg alternating with 0.25-mg/day HOLD on this
admission. takes at home.
16. Vit D 1,000 U daily
17. Lantus 100 unit/mL Solution Sig: Eight (8) units
Subcutaneous once a day.
18. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
19. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime.
20. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1)
Tablet PO every 6-8 hours as needed for pain: please LIMIT as
much as possible.
21. Ropinirole 0.5mg qhs HOLD - concern for confusion in the
past?
22. Lasix 100mg [**Hospital1 **]


Discharge Medications:
1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. captopril 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. cholecalciferol (vitamin D3) 400 unit Tablet Sig: 2.5 Tablets
PO DAILY (Daily).
4. quinidine gluconate 324 mg Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO Q8H (every 8 hours).
Disp:*90 Tablet Sustained Release(s)* Refills:*2*
5. escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. fondaparinux 7.5 mg/0.6 mL Syringe Sig: One (1)  Subcutaneous
DAILY (Daily).
7. furosemide 40 mg Tablet Sig: 2.5 Tablets PO BID (2 times a
day).
8. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. methylprednisolone 2 mg Tablet Sig: 2.5 Tablets PO DAILY
(Daily).
10. metoprolol tartrate 50 mg Tablet Sig: Four (4) Tablet PO BID
(2 times a day).
11. mirtazapine 30 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).

12. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO twice a day.
13. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. spironolactone 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
15. hydrocodone-acetaminophen 5-500 mg Tablet Sig: One (1)
Tablet PO Q4H (every 4 hours) as needed for back pain.
16. levalbuterol HCl 0.63 mg/3 mL Solution for Nebulization Sig:
One (1) ML Inhalation every 4 hours () as needed for SOB,
wheezing.
17. insulin glargine 100 unit/mL Cartridge Sig: Eight (8) Units
Subcutaneous once a day.
18. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
19. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Ventricular Fibrillation
Dilated Cardiomyopathy


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


Discharge Instructions:
You were admitted to the hospital for your ICD going off 3
times. You were found to be in a dangerous rhythm during those
episodes but your ICD shocked you out of it very quickly. We
started you on a medication called Quinidine which will help
protect your heart from going into these dangerous rhythms. You
had no further episodes while you were in the hospital. Please
follow up with Dr. [**Last Name (STitle) 1911**] to discuss your ICD.

The following changes were made to your medications:

STOP: Digitalis
STOP: Seroquel
STOP: Ropinirole

START: Quinidine

We held your Seroquel and Ropinirole while you were in the
hospital. Seroquel can cause arrythmias so please STOP this
medication. Ropinirole was discontinued at your last
hospitalization due to contributing to confusion. Please stop
this  medication.

Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs.

Followup Instructions:
Provider: [**Name10 (NameIs) 1918**] [**Name11 (NameIs) **] Phone:[**Telephone/Fax (1) 11767**]
Date/Time:[**2147-1-4**] 1:20
[**Doctor Last Name **],[**Location (un) **]
  [**Location (un) **] ([**Location (un) **], MA), [**Location (un) **]
  CVI [**Location (un) **] (NHB) [**Apartment Address(1) **]

Make sure to follow up with your primary care doctor within the
next 2 weeks. Please call your doctor [**First Name (Titles) **] [**Last Name (Titles) **] this
appointment.
{'Ventricular fibrillation,Fitting and adjustment of automatic implantable cardiac defibrillator,Other primary cardiomyopathies,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Old myocardial infarction,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Postinflammatory pulmonary fibrosis,Cardiac rhythm regulators causing adverse effects in therapeutic use,Long-term (current) use of insulin,Personal history of venous thrombosis and embolism,Personal history of tobacco use'}


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: ICD shocks

PRESENT ILLNESS: 60-year-old man with history of severe dilated cardiomyopathy
(EF 10-15%, non-ischemic, likely familial) status post ICD
implantation with a biventricular upgrade in [**12/2145**], amiodarone
induced pneumonitis, multiple DVTs, chronic atrial fibrillation,
HTN, HLD, DM2, who had a shock from his ICD on [**2146-12-7**] and
then another shock yesterday and a 3rd shock this AM. Prior to
this week, pt's last shock was in [**2146-3-28**]. Pt saw his EP
cardiologist, Dr. [**Last Name (STitle) 11649**], on [**2146-12-7**] after his shock,
who found that he had episode of V. fib and reccomended to
continue current medical management. During that particular
episode, pt reports that he felt dizzy, saw blackness, then was
shocked, and felt like he was in a daze a few minutes later.
Pt has had 3 shocks in the last 4 days. EP interrogated pacer
and found that pt was in V. fib each time.
He reported to OSH where vitals: T 97.7, HR 80, BP 98/58, RR 18,
94-96% RA. Trop 0.64. He had negative CXR. K+=3.5 and his L was
repleted. He was then transfered to [**Hospital1 18**].
In [**Hospital1 18**] ED: Vitals: T 98.5, HR 100, BP 107/76, RR 18, 95% RA.
EP saw pt and reported that he had 3 episodes of V fib last few
3 days. EKG in NSR no ST changes.
.
On review of systems, Denies chest pain, no SOB, no abd pain,
did have a mild headache that has resolved. Remainder of ROS
neg.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes (from steroids for
pneumonitis), +Dyslipidemia, +Hypertension
2. CARDIAC HISTORY:
history of an acute myocardial infarction due to a small embolic
event in [**5-/2145**] without any further intervention
3. OTHER PAST MEDICAL HISTORY:
- Dyslipidemia
- Hypertension
- Coronary Artery Disease - denied per family
- dilated cardiomyopathy, severely depressed EF (10-15%), s/p
ICD
[**2141**] for primary prevention
- Afib treated with digoxin
- polymorphic VT after dofetilide
- Amiodarone-induced hypersensitivity pneumonitis
- Diabetes, diagnosed after being on steroids for pneumonitis
- GI bleed on Coumadin [**2137**] possibly related to ischemic colitis

MEDICATION ON ADMISSION: 1. Aspirin 81 mg Tablet
2. Fondaparinux 7.5 mg/0.6 mL Syringe Sig: One (1) injection
Subcutaneous QHS (once a day (at bedtime)).
3. Escitalopram 10 mg daily
4. Methylprednisolone 5 mg per day
5. Omeprazole 40 mg Capsule, [**Hospital1 **]
6. Metoprolol Tartrate 200mg PO BID
7. Simvastatin 40 mg Tablet daily
8. Xopinex 0.63mg/3cc every 3 rs as needed for wheexing, SOB
9. Spironolactone 12.5 mg PO daily
10. Captopril 25 mg [**Hospital1 **]
11. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
12. Seroquel 100mg/day qhs
13. Digoxin 0.125-mg alternating with 0.25-mg/day HOLD on this
admission. takes at home.
16. Vit D 1,000 U daily
17. Lantus 100 unit/mL Solution Sig: Eight (8) units
Subcutaneous once a day.
18. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
19. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime.
20. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1)
Tablet PO every 6-8 hours as needed for pain: please LIMIT as
much as possible.
21. Ropinirole 0.5mg qhs HOLD - concern for confusion in the
past?
22. Lasix 100mg [**Hospital1 **]

ALLERGIES: Amiodarone

PHYSICAL EXAM: Admission Exam
VS: afebrile, BP= 124/82, HR=82, O2 sat= 97% on 2L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: There is family history of premature coronary artery disease in

SOCIAL HISTORY: Social history is significant for the absence of current tobacco 

### Response:
{'Ventricular fibrillation,Fitting and adjustment of automatic implantable cardiac defibrillator,Other primary cardiomyopathies,Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Old myocardial infarction,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Postinflammatory pulmonary fibrosis,Cardiac rhythm regulators causing adverse effects in therapeutic use,Long-term (current) use of insulin,Personal history of venous thrombosis and embolism,Personal history of tobacco use'}
