CHIEF COMPLAINT: Status post ethanol ablation.

PRESENT ILLNESS: The patient is a 45-year-old
white male with hypertrophic cardiomyopathy presenting today
status post ethanol septal ablation procedure.  Mr. [**Known lastname 36365**]
was diagnosed with hypertrophic subacute severe aortic
stenosis in [**2156-2-12**] after presenting to EMMC with
severe chest pain in the setting of several years of dyspnea
on exertion and anginal chest pain.  After a series of
negative enzymes and negative ETT [**Last Name (LF) 1608**], [**First Name3 (LF) **] echocardiogram
showed marked systolic anterior motion with a dynamic outflow
obstruction with a peak gradient of 32.  On catheterization,
the patient had a systolic gradient of 130 post premature
ventricular contractions and 96 post Valsalva.  Despite a
trial of medical therapy, the patient continued to have
symptoms of dyspnea on exertion that were significantly
debilitating.  He was thus referred to [**Hospital6 649**] for ethanol ablation.

MEDICAL HISTORY: 1.  Idiopathic hypertrophic subaortic stenosis.
2.  Catheterization on [**2156-2-23**] revealed no
significant coronary artery disease.
3.  Hyperlipidemia.
4.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Quit tobacco 45 years ago. He is married.
He drinks about two cases of beer per week.  History of
cocaine and marijuana abuse as recently as 15 years ago.
Other and unspecified hyperlipidemia,Unspecified essential hypertension
Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2156-12-27**]     Discharge Date:  [**2156-12-30**]

Date of Birth:   [**2111-12-11**]     Sex:  M

Service:  CCU

CHIEF COMPLAINT:  Status post ethanol ablation.

HISTORY OF PRESENT ILLNESS:  The patient is a 45-year-old
white male with hypertrophic cardiomyopathy presenting today
status post ethanol septal ablation procedure.  Mr. [**Known lastname 36365**]
was diagnosed with hypertrophic subacute severe aortic
stenosis in [**2156-2-12**] after presenting to EMMC with
severe chest pain in the setting of several years of dyspnea
on exertion and anginal chest pain.  After a series of
negative enzymes and negative ETT [**Last Name (LF) 1608**], [**First Name3 (LF) **] echocardiogram
showed marked systolic anterior motion with a dynamic outflow
obstruction with a peak gradient of 32.  On catheterization,
the patient had a systolic gradient of 130 post premature
ventricular contractions and 96 post Valsalva.  Despite a
trial of medical therapy, the patient continued to have
symptoms of dyspnea on exertion that were significantly
debilitating.  He was thus referred to [**Hospital6 649**] for ethanol ablation.

In the catheterization laboratory, patient's resting gradient
was not significantly elevated but a dobutamine induced
gradient was between 160-200 mmHg.  He underwent an ethanol
ablation without complications and was sent up to the
Coronary Care Unit in stable condition.  When patient was
seen in the Coronary Care Unit, he complained of mild right
sternal discomfort, but no shortness of breath, headache,
palpitations, lightheadedness, cough, groin pain or leg
weakness, numbness.

PAST MEDICAL HISTORY:
1.  Idiopathic hypertrophic subaortic stenosis.
2.  Catheterization on [**2156-2-23**] revealed no
significant coronary artery disease.
3.  Hyperlipidemia.
4.  Hypertension.

MEDICATIONS:
1.  Verapamil 240 mg po b.i.d.
2.  Aspirin 325 mg po q.d.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Quit tobacco 45 years ago. He is married.
He drinks about two cases of beer per week.  History of
cocaine and marijuana abuse as recently as 15 years ago.

FAMILY HISTORY:  Unknown.

PHYSICAL EXAMINATION:  General:  Well-appearing 45-year-old
white male in no apparent distress.  Vital signs:  Heart rate
87.  Blood pressure 150/97.  Respiratory rate 12.  Oxygen
saturation 100%.  Head, eyes, ears, nose and throat:
Normocephalic, atraumatic.  Neck supple.  Chest:  Clear to
auscultation anteriorly.  Cardiovascular normal, S1, S2
normal with 2/6 systolic ejection murmur at left lower
sternal border radiating to apex, rate increasing with
Valsalva.  Abdomen soft, nontender with normal bowel sounds.
Extremities:  No cyanosis, clubbing or edema.

LABORATORIES:  On [**2156-12-22**]:  White blood cell count
9.6, hematocrit 41.6, platelets 333,000.  Sodium 141,
potassium 4, chloride 101, bicarbonate 27, BUN 19, creatinine
1.2, glucose 64, INR 0.97.  Electrocardiogram:  Baseline
normal sinus rhythm with septal hypertrophy, left axis
deviation.  Post catheterization normal sinus rhythm.  Septal
hypertrophy, slight ST depression and T wave inversion in
aVL.  Catheterization results:  Left ventricular pressures
147/6 with dobutamine 342. After ablation with dobutamine
180/14.

ASSESSMENT:  Patient was a 45-year-old white male with
hypertrophic cardiomyopathy who presented now status post
ethanol ablation.

HOSPITAL COURSE:  By systems:

Pump:

1.  Cardiac:  The patient had septal ablation with ethanol to
improve his idiopathic hypertrophic subaortic stenosis.  He
tolerated the procedure well.  He was sent to the Coronary
Care Unit after the ethanol ablation because of the risk for
developing bradyarrhythmias.  He had a temporary wire placed
in the catheterization laboratory in case he became
bradyarrhythmic.  His calcium channel blocker was held in the
setting of this situation.  The aspirin was still continued.
He had been mildly hypertensive after the procedure.  He was
started on Captopril 12.5 mg po t.i.d. in the setting of his
hypertension since his verapamil and beta-blockers were held
in the setting of possible development of bradyarrhythmias.
After the ablation therapy, his left ventricular outflow
gradient was improved.  It will need some time to determine
how well his exertional tolerance will be.  Because of the
fear for lowering his after load reduction, he was switched
to metoprolol.  His Captopril was discontinued.  His
telemetry events only showed premature ventricular
contractions, but no evidence of bradyarrhythmias.

On the third day of admission, his metoprolol was increased
to 25 mg po t.i.d. and he was restarted on his calcium
channel blocker as the window of developing bradyarrhythmias
is narrowed.  He had been tachycardiac and the beta-blocker
was started and increased and the verapamil was restarted to
improve his heart rate control.  His blood pressure improved
and he was no longer hypertensive.  His murmur also decreased
likely from improved hemodynamics and decreased heart rate.
His pacemaker was removed on the third day of admission.  On
the fourth day of admission, he was transferred to the floor.
On the fourth day of admission, it was felt that his risk for
developing arrhythmias was significantly decreased.  He had
improved hemodynamics and his murmur was much reduced.  Rate
was under improved control between 70 and 90.  His blood
pressure was also improved and he was no longer hypertensive.
His CK was done after the procedure with first CK of 588, MB
of 22, index of 4.3.  His second one was 244 and his third
one was only 155, MB of 4.  Subsequently, he did have an
acute increase in his CKs, status post ablation which was
expected, however, and on discharge his CKs were trending
downward.

2.  Pain:  The patient was started on Percocet for his pain
and had adequate pain control with Percocet prn on a prn
basis.

3.  Pulmonary:  On the second day of admission, the patient
had an oxygen desaturation while sleeping.  He normally was
in the mid 90s to upper 90s on oxygen saturation, however, he
decreased to 91% while sleeping.  It was felt that the
patient who has a thick neck may have sleep apnea and may
benefit from further work-up of that condition.

Patient was discharged back to home on the following
medications:

DISCHARGE MEDICATIONS:
1.  Verapamil 180 mg po q.d.
2.  Metoprolol 25 mg po t.i.d.
3.  Aspirin 325 mg po q.d.

FOLLOW-UP:  He is to follow-up with his cardiologist at home.
Patient actually left without a prescription for the
medications.  His local clinic was notified and he received
his prescriptions through them.

DISCHARGE DIAGNOSES:
1.  Hypertrophic cardiomyopathy.
2.  Hypertension.

DISCHARGE STATUS:  Patient is to be discharged back to home.

DISCHARGE CONDITION:  Patient was in fair condition.








                          [**First Name8 (NamePattern2) 2053**] [**Last Name (NamePattern1) 2052**], M.D.  [**MD Number(1) **]

Dictated By:[**Name8 (MD) 4523**]

MEDQUIST36

D:  [**2157-3-22**]  11:26
T:  [**2157-3-22**]  11:26
JOB#:  [**Job Number 36366**]
{'Other and unspecified hyperlipidemia,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: Status post ethanol ablation.

PRESENT ILLNESS: The patient is a 45-year-old
white male with hypertrophic cardiomyopathy presenting today
status post ethanol septal ablation procedure.  Mr. [**Known lastname 36365**]
was diagnosed with hypertrophic subacute severe aortic
stenosis in [**2156-2-12**] after presenting to EMMC with
severe chest pain in the setting of several years of dyspnea
on exertion and anginal chest pain.  After a series of
negative enzymes and negative ETT [**Last Name (LF) 1608**], [**First Name3 (LF) **] echocardiogram
showed marked systolic anterior motion with a dynamic outflow
obstruction with a peak gradient of 32.  On catheterization,
the patient had a systolic gradient of 130 post premature
ventricular contractions and 96 post Valsalva.  Despite a
trial of medical therapy, the patient continued to have
symptoms of dyspnea on exertion that were significantly
debilitating.  He was thus referred to [**Hospital6 649**] for ethanol ablation.

MEDICAL HISTORY: 1.  Idiopathic hypertrophic subaortic stenosis.
2.  Catheterization on [**2156-2-23**] revealed no
significant coronary artery disease.
3.  Hyperlipidemia.
4.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Quit tobacco 45 years ago. He is married.
He drinks about two cases of beer per week.  History of
cocaine and marijuana abuse as recently as 15 years ago. 

### Response:
{'Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
