CHIEF COMPLAINT: transfer from [**Hospital 7168**] hospital for ventricular tachycardia and
potential EP study and ablation procedure

PRESENT ILLNESS: Mr [**Known lastname 32729**] is an 82 yo with h/o CAD s/p large anterior MI at
age 36 with EF 25%; 2 vessel CAGB in [**2104**] (LIMA to LAD; SVG to
OM); s/p SNTEMI [**10/2114**] with stent to native L circ. He had a
pacemaker/defibrillator placed in [**2114**] for primary prevention;
he had an episode of VTach in [**2115**] causing syncope and was begun
on amiodarone (d/c'd) and then procainamide since 4/[**2116**]. This
was recently decreased from 1000mg po tid to 500mg tid.
.
He presented to [**Hospital **] hospital on [**11-17**] after 1 day of
intermittent palpitations that kept him awake most of the night
of [**2037-11-14**]. Later that day he reported associated light
headedness/diaphoresis which prompted him to go to the ED. He
denied any chest pain or shortness of breath, LOC associated
with these episodes. At [**Location (un) 14078**] he was found to have 150
episodes of VT. Overnight he evidently had 10 episodes
ventricular tachycardia (asymptomatic) and is transferred to
[**Hospital1 18**] for EP study and possible ablation.
.
Otherwise Mr. [**Known lastname 32729**] is feeling well. He denies any CP, SOB,
or current lightheadedness. At baseline he can walk the length
of a long corridor without significant SOB. His walking is
limited by orthopedic problems rather than dyspnea. He has been
compliant with all of his medications.

MEDICAL HISTORY: # CAD s/p large anterior MI at age 36;
# 2 vessel CABG [**2101**] LIMA to LAD; SVG to OM
# NSTEMI [**10/2114**] s/p stent to native L circ.
# CHF with LV EF of 25%
# Ventricular Tachycardia: had pacemaker placed in [**2114**] for
primary prevention (MADIT criteria); had [**Hospital1 18**] hospitalization
[**3-26**] (started on amio; d/c'd due to "balance disorder/falls"),
started on procainamide [**12/2116**]; decreased from 1000mg tid to
500mg tid with level 7.2 on [**10-15**].
# s/p [**Company **] [**Last Name (un) **] pacer/defibrillator [**2116-12-31**] (Madit II
criteria)
# atrial flutter: recenty hospitalized at [**Hospital1 18**]
# CRI with baseline Cr in low 2 range
# ???L arm emolism; on coumadin since [**7-/2116**]
# B achilles tendon rupture [**12-24**] ciprofloxacin
# Prostate CA: s/p brachytherapy
# osteoarthritis (currently taking prednisone)
.

MEDICATION ON ADMISSION: ASA 81
# digoxin 0.0625 dialy
# coumadin 3
# losartan 25mg daily
# metoprolol 25 [**Hospital1 **]
# procanamide 500mg po tid
# lasix 20 mg po daily
# zetia 10mg po daily
# folate 1mg po daily
# omeprazole 25mg po daily
# Detrol 5mg po daily
# flomax 0.5mg daily
# prednisone 5mg daily (for ?arthritis?)

ALLERGIES: Ciprofloxacin / Amiodarone

PHYSICAL EXAM: HR 63 (atrially paced); BP 104/76; T 98.1; RR 13 98% RA
Gen: well-appearing elderly male in NAD
HEENT: NCAT, MMM
CV: RRR grade 2-3/6 mid-peaking systolic murmur heard best at
RUSB and LUSB; No radiation to carotids or axilla. No JVD
Pulm: Clear B
Abd: s/nd/nt
Extremities: warm, well-perfused; 2+ DP pulses B; good groin
pulses, no bruits

FAMILY HISTORY: Father died with CAD; healthy son; daughter with [**Name2 (NI) 95740**]

SOCIAL HISTORY: retired; works as volunteer at local hospital. Remote smoking
history, no EtOH
Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Chronic kidney disease, unspecified,Hemopericardium,Congestive heart failure, unspecified,Other iatrogenic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Old myocardial infarction,Esophageal reflux,Malignant neoplasm of prostate,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Automatic implantable cardiac defibrillator in situ,Aortocoronary bypass status
Parox ventric tachycard,Hematoma complic proc,Chronic kidney dis NOS,Hemopericardium,CHF NOS,Iatrogenc hypotnsion NEC,Cor ath unsp vsl ntv/gft,Old myocardial infarct,Esophageal reflux,Malign neopl prostate,Osteoarthros NOS-unspec,Status autm crd dfbrltr,Aortocoronary bypass
Admission Date:  [**2117-11-18**]              Discharge Date:   [**2117-11-24**]


Service: MEDICINE

Allergies:
Ciprofloxacin / Amiodarone

Attending:[**Doctor First Name 1402**]
Chief Complaint:
transfer from [**Hospital 7168**] hospital for ventricular tachycardia and
potential EP study and ablation procedure

Major Surgical or Invasive Procedure:
[**2117-11-19**] EP study for VT ablation
[**2117-11-19**] Pericardiacentesis with drain
[**2117-11-20**] Drain removed


History of Present Illness:
Mr [**Known lastname 32729**] is an 82 yo with h/o CAD s/p large anterior MI at
age 36 with EF 25%; 2 vessel CAGB in [**2104**] (LIMA to LAD; SVG to
OM); s/p SNTEMI [**10/2114**] with stent to native L circ. He had a
pacemaker/defibrillator placed in [**2114**] for primary prevention;
he had an episode of VTach in [**2115**] causing syncope and was begun
on amiodarone (d/c'd) and then procainamide since 4/[**2116**]. This
was recently decreased from 1000mg po tid to 500mg tid.
.
He presented to [**Hospital **] hospital on [**11-17**] after 1 day of
intermittent palpitations that kept him awake most of the night
of [**2037-11-14**]. Later that day he reported associated light
headedness/diaphoresis which prompted him to go to the ED. He
denied any chest pain or shortness of breath, LOC associated
with these episodes. At [**Location (un) 14078**] he was found to have 150
episodes of VT. Overnight he evidently had 10 episodes
ventricular tachycardia (asymptomatic) and is transferred to
[**Hospital1 18**] for EP study and possible ablation.
.
Otherwise Mr. [**Known lastname 32729**] is feeling well. He denies any CP, SOB,
or current lightheadedness. At baseline he can walk the length
of a long corridor without significant SOB. His walking is
limited by orthopedic problems rather than dyspnea. He has been
compliant with all of his medications.


Past Medical History:
# CAD s/p large anterior MI at age 36;
# 2 vessel CABG [**2101**] LIMA to LAD; SVG to OM
# NSTEMI [**10/2114**] s/p stent to native L circ.
# CHF with LV EF of 25%
# Ventricular Tachycardia: had pacemaker placed in [**2114**] for
primary prevention (MADIT criteria); had [**Hospital1 18**] hospitalization
[**3-26**] (started on amio; d/c'd due to "balance disorder/falls"),
started on procainamide [**12/2116**]; decreased from 1000mg tid to
500mg tid with level 7.2 on [**10-15**].
# s/p [**Company **] [**Last Name (un) **] pacer/defibrillator [**2116-12-31**] (Madit II
criteria)
# atrial flutter: recenty hospitalized at [**Hospital1 18**]
# CRI with baseline Cr in low 2 range
# ???L arm emolism; on coumadin since [**7-/2116**]
# B achilles tendon rupture [**12-24**] ciprofloxacin
# Prostate CA: s/p brachytherapy
# osteoarthritis (currently taking prednisone)
.


Social History:
retired; works as volunteer at local hospital. Remote smoking
history, no EtOH

Family History:
Father died with CAD; healthy son; daughter with [**Name2 (NI) 95740**]

Physical Exam:
 HR 63 (atrially paced); BP 104/76; T 98.1; RR 13 98% RA
Gen: well-appearing elderly male in NAD
HEENT: NCAT, MMM
CV: RRR grade 2-3/6 mid-peaking systolic murmur heard best at
RUSB and LUSB; No radiation to carotids or axilla. No JVD
Pulm: Clear B
Abd: s/nd/nt
Extremities: warm, well-perfused; 2+ DP pulses B; good groin
pulses, no bruits


Pertinent Results:
[**2117-11-18**] 01:56PM   PT-22.8* PTT-33.2 INR(PT)-2.3*
[**2117-11-18**] 01:56PM   PLT COUNT-195
[**2117-11-18**] 01:56PM   WBC-6.5 RBC-4.19* HGB-12.9* HCT-38.2* MCV-91
MCH-30.8 MCHC-33.8 RDW-13.9
[**2117-11-18**] 01:56PM   ALBUMIN-4.0 CALCIUM-9.4 PHOSPHATE-2.5*
MAGNESIUM-2.1
[**2117-11-18**] 01:56PM   GLUCOSE-114* UREA N-36* CREAT-2.2* SODIUM-137
POTASSIUM-4.6 CHLORIDE-103 TOTAL CO2-27 ANION GAP-12
.
Proc: 8.9, NAPA: 11.4
.
Tx reaction w/u: negative
.
Cx: all no growth
.
[**11-19**] eccho:
The left ventricular cavity is moderately dilated. LV systolic
function
appears depressed. The right ventricular cavity is unusually
small. There is a moderate sized pericardial effusion. There is
severe right ventricular compression, consistent with impaired
fillling/tamponade physiology.

[**11-24**] eccho:
Left ventricular wall thicknesses and cavity size are normal.
There is
moderate to severe regional left ventricular systolic
dysfunction. No masses or thrombi are seen in the left
ventricle. Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets are thickened. The mitral
valve leaflets are mildly thickened. There is a small to
moderate sized pericardial effusion measuring ~1.2cm anterior to
the right ventricle and right atrium, and <1cm posterior to the
left ventricle and left atrium. Transmitral Doppler does not
suggest hemodynamic compromise.
Compared with the prior study (images reviewed) of [**2117-11-23**], the
size of the posterior effusion is slightly smaller.


Brief Hospital Course:
A/P 82 yo with CAD s/p old IMI, 2 vessel CABG in [**2101**], NSTEMI in
[**2113**] with stent to native L circ, CHF with EF 25-30%, VT s/p ICD
placement presenting with recurrent VT. Briefly, Mr [**Known lastname 32729**]
was admitted w/o evidence of sustained VT on telemetry.  He had
successful ablation of LV scar but this procedure was
complicated by pericardial effusion/tamponade.
.
# Cardiac:
-- Rhythm: Patient had recurrent VT likely [**12-24**] old IMI with
scar. His procainamide dose was increased to 750mg po tid  (goal
proc level 8) with similar metoprolol dose at 50mg toprol XL
daily. He had a successful VT ablation with mapping complicated
by bloody pericardial effusion/tamponade and groin bleed (see
below). His pacemaker was reset to 80 bpm; there has been an
advisory on his specific pacemaker and he was instructed to
place a magnet to it daily to ensure that it is working
correctly.  Mr [**Known lastname 95741**] ablation was complicated by
hemorrhagic effusion causing tamponade requiring pericardial
drain (140cc off).  The drain was pulled and repeat eccho
initially showed some small reaccumulation which was
subsuquently stable with no evidence tamponade.
-- CAD: s/p IMI at age 36, CABG [**2103**] with SVG to OM and LIMA to
LAD, NSTEMI [**2113**] with PTCA to L circ;  He was kept on
metoprolol, losartan, aspirin, and statin
-- Pump: baseline of EF 25-30%; symptomatically NYHA class II.
During hospitalization had several episodes of hypotension, one
resolving with draining of pericardial fluid, one with a NS
bolus of 500cc and dopamine. Thought to be in setting of
tamponade phsyiology and hypovolemia. This resolved quickly and
he has been normotense on home antihypertensive regimen
(metoprolol XL 50, losartan 25) for several days prior to
discharge.
.
# Groin Bleed/Hematoma: Patient had groin bleed/hematoma in
setting of elevtaed INR (coumadin outpt) and instrumentation in
fem art for EP study. Direct pressure and pressure dressing
applied with good effect. Anticoagulation was reversed with FFP,
a small amount of vit K and protamine. He did not require any
pRBC transfusion.  His anticoagulation was discontinued (as
below).
.
# Rigors/Fever: Patient had rigors during groin bleed
Differential includes transfusion reaction from FFP or
bacteremia (transient or otherwise) from lines/lungs. All cx
NGTD; the patient otherwise remained AF the rest of his hospital
course.  he was briefly covered with vancomycin.
.
# CRI: Baseline Cr of 2.1-2.3. Not an acute issue
.
# L arm thrombosis: Discontinued anticoagulation as he has been
anticoagulated for over 6 mos and likely no further indication.

.
# Arthritis: continued prednisone as per outpatient PCP
(although this is not likely an appropriate regimen).  he was
adrenally sufficient.
.
# Prostate CA: outpt managmement, continued home medications of
flomax and detrol.
.
# FEN/GI: Euvolemic on admission; low-salt cardiac diet.  Put
back on outpt lasix dose on discharge.
.
# Mr [**Known lastname 32729**] is discharged with f/u in 2 days with Dr.
[**Last Name (STitle) **].

Medications on Admission:
 ASA 81
# digoxin 0.0625 dialy
# coumadin 3
# losartan 25mg daily
# metoprolol 25 [**Hospital1 **]
# procanamide 500mg po tid
# lasix 20 mg po daily
# zetia 10mg po daily
# folate 1mg po daily
# omeprazole 25mg po daily
# Detrol 5mg po daily
# flomax 0.5mg daily
# prednisone 5mg daily (for ?arthritis?)


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
8. Detrol LA 4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO once a day.
9. Procainamide 250 mg Capsule Sig: Three (3) Capsule PO three
times a day.
Disp:*270 Capsule(s)* Refills:*2*
10. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q12H
(every 12 hours) for 5 days.
Disp:*10 Capsule(s)* Refills:*0*
11. Losartan 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*2*
12. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] VNA

Discharge Diagnosis:
Primary diagnosis:
Ventricular tachycardia
cardiac tamponade
systolic left ventricular dysfunction congestive heart failure
chronic renal insufficiency
CAD
.
Secondary diagnosis:
arthritis
prostate CA
GERD


Discharge Condition:
ambulating, tolerating oral intake, vital signs stable.


Discharge Instructions:
You were admitted because you had an arrythmia. You had a
procedure to ablate your ventricular tachycardia and had the
complication of some fluid around your heart called "cardaic
tamponade".  You then had a drain placed into your heart sac
which was removed.  If this fluid reaccumulates you could have
symptoms such as light headedness, severe fatigue, low blood
pressure, lower extremity swelling, or difficulty breathing.  If
you have any of these symtpoms you should go to the emergency
room or seek prompt medical attention.  You should also seek
medical attention if you have chest pain, worsening shortness of
breath, palpitations, fevers, or for any other concerns.
.
You are being treated with antibiotics, Keflex or cephalexin,
and should continue a total 7 day course.
.
You should continue the medications we have prescribed for you.
We have increased your procainamide dose and made changes to the
doses of other medications as well.  You will need to go see Dr.
[**Last Name (STitle) **] on Friday (see below).
.
YOu should continue with a low sodium diet (2grams per day) and
weigh yourself daiy; if you gain >2lbs or if you have trouble
breathing you should contact your doctor.  You should also limit
your fluid intake to 1.5L per day.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 40075**] in [**5-31**] days at [**Telephone/Fax (1) 40076**].
You will need to have your procainamide level checked and
potassium and BUN, Creatinine checked.  We tried to make you the
follow up appointment but could not get through.
.
Follow up appointment with Dr. [**Last Name (STitle) **] in cardiology on Friday
[**2117-11-26**] at 12:30pm.  [**Hospital Ward Name 516**] [**Hospital1 18**] in the [**Hospital Ward Name 23**] Building on
the [**Location (un) 436**].  [**Telephone/Fax (1) 2934**]
{'Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Chronic kidney disease, unspecified,Hemopericardium,Congestive heart failure, unspecified,Other iatrogenic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Old myocardial infarction,Esophageal reflux,Malignant neoplasm of prostate,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Automatic implantable cardiac defibrillator in situ,Aortocoronary bypass 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: transfer from [**Hospital 7168**] hospital for ventricular tachycardia and
potential EP study and ablation procedure

PRESENT ILLNESS: Mr [**Known lastname 32729**] is an 82 yo with h/o CAD s/p large anterior MI at
age 36 with EF 25%; 2 vessel CAGB in [**2104**] (LIMA to LAD; SVG to
OM); s/p SNTEMI [**10/2114**] with stent to native L circ. He had a
pacemaker/defibrillator placed in [**2114**] for primary prevention;
he had an episode of VTach in [**2115**] causing syncope and was begun
on amiodarone (d/c'd) and then procainamide since 4/[**2116**]. This
was recently decreased from 1000mg po tid to 500mg tid.
.
He presented to [**Hospital **] hospital on [**11-17**] after 1 day of
intermittent palpitations that kept him awake most of the night
of [**2037-11-14**]. Later that day he reported associated light
headedness/diaphoresis which prompted him to go to the ED. He
denied any chest pain or shortness of breath, LOC associated
with these episodes. At [**Location (un) 14078**] he was found to have 150
episodes of VT. Overnight he evidently had 10 episodes
ventricular tachycardia (asymptomatic) and is transferred to
[**Hospital1 18**] for EP study and possible ablation.
.
Otherwise Mr. [**Known lastname 32729**] is feeling well. He denies any CP, SOB,
or current lightheadedness. At baseline he can walk the length
of a long corridor without significant SOB. His walking is
limited by orthopedic problems rather than dyspnea. He has been
compliant with all of his medications.

MEDICAL HISTORY: # CAD s/p large anterior MI at age 36;
# 2 vessel CABG [**2101**] LIMA to LAD; SVG to OM
# NSTEMI [**10/2114**] s/p stent to native L circ.
# CHF with LV EF of 25%
# Ventricular Tachycardia: had pacemaker placed in [**2114**] for
primary prevention (MADIT criteria); had [**Hospital1 18**] hospitalization
[**3-26**] (started on amio; d/c'd due to "balance disorder/falls"),
started on procainamide [**12/2116**]; decreased from 1000mg tid to
500mg tid with level 7.2 on [**10-15**].
# s/p [**Company **] [**Last Name (un) **] pacer/defibrillator [**2116-12-31**] (Madit II
criteria)
# atrial flutter: recenty hospitalized at [**Hospital1 18**]
# CRI with baseline Cr in low 2 range
# ???L arm emolism; on coumadin since [**7-/2116**]
# B achilles tendon rupture [**12-24**] ciprofloxacin
# Prostate CA: s/p brachytherapy
# osteoarthritis (currently taking prednisone)
.

MEDICATION ON ADMISSION: ASA 81
# digoxin 0.0625 dialy
# coumadin 3
# losartan 25mg daily
# metoprolol 25 [**Hospital1 **]
# procanamide 500mg po tid
# lasix 20 mg po daily
# zetia 10mg po daily
# folate 1mg po daily
# omeprazole 25mg po daily
# Detrol 5mg po daily
# flomax 0.5mg daily
# prednisone 5mg daily (for ?arthritis?)

ALLERGIES: Ciprofloxacin / Amiodarone

PHYSICAL EXAM: HR 63 (atrially paced); BP 104/76; T 98.1; RR 13 98% RA
Gen: well-appearing elderly male in NAD
HEENT: NCAT, MMM
CV: RRR grade 2-3/6 mid-peaking systolic murmur heard best at
RUSB and LUSB; No radiation to carotids or axilla. No JVD
Pulm: Clear B
Abd: s/nd/nt
Extremities: warm, well-perfused; 2+ DP pulses B; good groin
pulses, no bruits

FAMILY HISTORY: Father died with CAD; healthy son; daughter with [**Name2 (NI) 95740**]

SOCIAL HISTORY: retired; works as volunteer at local hospital. Remote smoking
history, no EtOH 

### Response:
{'Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Chronic kidney disease, unspecified,Hemopericardium,Congestive heart failure, unspecified,Other iatrogenic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Old myocardial infarction,Esophageal reflux,Malignant neoplasm of prostate,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Automatic implantable cardiac defibrillator in situ,Aortocoronary bypass status'}
