CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: 89 y/o F chinese-speaking female with severe diastolic heart
failure, atrial fibrillation not on anticoagulation, diabetes,
hypertension, hyperlipidemia who presents with worsening DOE/SOB
for past 3 days. Patient was seen for worsening dyspnea and
shortness of breath by Dr. [**First Name (STitle) 437**] in heart failure clinic [**2154-8-26**]
and at that time the patient's was started on lasix 20mg daily
and increased toprol dose. Per family, patient's lower extremity
edema improved, but dyspnea persisted. Also intermittant CP,
lasts >5min, occurring several times a day, no current pain and
no pain in ED.
.
In ED, Temp 97.5, HR 75 BP 123/91 RR 26 Pox 98 on 3 LNC. CXR
showed retrocardiac opacity and new bilateral pleural effusions.
No n/v, abd pain, f/c, cough, chest pain. In ED, he received
Levofloxacin 750 mg iv, and nitro SL. She initially had some
relief with better dyspnea after getting nitro. Got 250 ml bolus
and then had respiratory distress and was intuabted. Lactate
3.4.
.
On the floor, patient is intubated and sedated. Family is at the
bedside. She is in atrial fibrillation and her BP is stable.

MEDICAL HISTORY: -Severe diastolic congestive heart failure
-Pulm HTN
-Mod to severe mitral regurgitation
-Diabetes mellitus
-Hypertension
-Hyperlipidemia
-Osteoporosis
-Glaucoma
-h/o gout ([**3-18**])
-h/o appendicitis last year with septic shock ([**Hospital3 **])

MEDICATION ON ADMISSION: Alendronate [Fosamax] 35 mg Tablet weekly (friday)
Atorvastatin [Lipitor] 10 mg daily
Furosemide 20 mg Tablet daily
Lisinopril 10 mg Tablet daily
Metformin 500 mg Tablet Sustained Release 24 hr daily
Metoprolol Succinate 50 mg daily
Polyethylene Glycol 17 gm daily
Aspirin 81 mg Tablet daily
Calcium 500 mg Tablet daily
Multivitamin daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE on admission:
Vitals: T: 96.6, BP: 118/75, P: 93 (afib), R: 16, O2: 100% AC
100%/5/450/16 with ABG 7.45/29/506
General: thin, eldery, intubated and sedated
HEENT: Sclera anicteric, MMM, oropharynx clear, pupils 3mm and
reactive
Neck: supple, JVP not elevated, no LAD
Lungs: coarse lung sounds bilaterally, crackles at the bases, no
wheezes, referred ventilator sounds
CV: irregularly irregular, 2/6 systolic murmur best heard at
LLSB
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: cool, palp pulses, no clubbing, no edema

FAMILY HISTORY: Circulatory disorders in her father and uncle, otherwise
noncontributory.

SOCIAL HISTORY: The patient is originally from [**Female First Name (un) 8489**]. She lives in [**Location 583**] with
her daughter currently. [**Name2 (NI) **] tobacco use, no alcohol use, no drug
use.  Functional status is poor, but does get around the house
and has normal mental capacity, no known dementia.
Acute on chronic diastolic heart failure,Acute respiratory failure,Other primary cardiomyopathies,Atrial flutter,Dehydration,Mitral valve disorders,Unspecified essential hypertension,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Unspecified glaucoma,Gout, unspecified,Anemia, unspecified,Other postprocedural status
Ac on chr diast hrt fail,Acute respiratry failure,Prim cardiomyopathy NEC,Atrial flutter,Dehydration,Mitral valve disorder,Hypertension NOS,Iatrogenc hypotnsion NEC,DMII wo cmp nt st uncntr,Chr pulmon heart dis NEC,Osteoporosis NOS,Hyperlipidemia NEC/NOS,Glaucoma NOS,Gout NOS,Anemia NOS,Post-proc states NEC
Admission Date:  [**2154-9-7**]              Discharge Date:   [**2154-9-15**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4071**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
TEE
Cardioversion
Intubation
Extubation
PICC line placement

History of Present Illness:
89 y/o F chinese-speaking female with severe diastolic heart
failure, atrial fibrillation not on anticoagulation, diabetes,
hypertension, hyperlipidemia who presents with worsening DOE/SOB
for past 3 days. Patient was seen for worsening dyspnea and
shortness of breath by Dr. [**First Name (STitle) 437**] in heart failure clinic [**2154-8-26**]
and at that time the patient's was started on lasix 20mg daily
and increased toprol dose. Per family, patient's lower extremity
edema improved, but dyspnea persisted. Also intermittant CP,
lasts >5min, occurring several times a day, no current pain and
no pain in ED.
.
In ED, Temp 97.5, HR 75 BP 123/91 RR 26 Pox 98 on 3 LNC. CXR
showed retrocardiac opacity and new bilateral pleural effusions.
No n/v, abd pain, f/c, cough, chest pain. In ED, he received
Levofloxacin 750 mg iv, and nitro SL. She initially had some
relief with better dyspnea after getting nitro. Got 250 ml bolus
and then had respiratory distress and was intuabted. Lactate
3.4.
.
On the floor, patient is intubated and sedated. Family is at the
bedside. She is in atrial fibrillation and her BP is stable.


Past Medical History:
-Severe diastolic congestive heart failure
-Pulm HTN
-Mod to severe mitral regurgitation
-Diabetes mellitus
-Hypertension
-Hyperlipidemia
-Osteoporosis
-Glaucoma
-h/o gout ([**3-18**])
-h/o appendicitis last year with septic shock ([**Hospital3 **])

-h/o atrial fibrillation (during hospitalization one year ago,
not on coumadin, and discussed at last cards visit [**8-26**] and
daughter wanted to not initiate coumadin)
- h/o TEE electrocardioversion during hospitalization; has not
had atrial fibrillation until past few weeks


Social History:
The patient is originally from [**Female First Name (un) 8489**]. She lives in [**Location 583**] with
her daughter currently. [**Name2 (NI) **] tobacco use, no alcohol use, no drug
use.  Functional status is poor, but does get around the house
and has normal mental capacity, no known dementia.


Family History:
Circulatory disorders in her father and uncle, otherwise
noncontributory.

Physical Exam:
PE on admission:
Vitals: T: 96.6, BP: 118/75, P: 93 (afib), R: 16, O2: 100% AC
100%/5/450/16 with ABG 7.45/29/506
General: thin, eldery, intubated and sedated
HEENT: Sclera anicteric, MMM, oropharynx clear, pupils 3mm and
reactive
Neck: supple, JVP not elevated, no LAD
Lungs: coarse lung sounds bilaterally, crackles at the bases, no
wheezes, referred ventilator sounds
CV: irregularly irregular, 2/6 systolic murmur best heard at
LLSB
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: cool, palp pulses, no clubbing, no edema


Pertinent Results:
LABORATORIES:
[**2154-9-7**] 04:18PM BLOOD WBC-8.4 RBC-4.11* Hgb-13.1 Hct-41.9
MCV-102* MCH-32.0 MCHC-31.4 RDW-13.9 Plt Ct-232
[**2154-9-15**] 06:02AM BLOOD WBC-7.6 RBC-3.32* Hgb-10.9* Hct-33.0*
MCV-99* MCH-32.9* MCHC-33.1 RDW-14.4 Plt Ct-225

[**2154-9-7**] 04:18PM BLOOD PT-14.7* PTT-37.2* INR(PT)-1.3*
[**2154-9-15**] 06:02AM BLOOD PT-32.8* PTT-50.4* INR(PT)-3.3*

[**2154-9-7**] 04:18PM BLOOD Glucose-144* UreaN-37* Creat-1.0 Na-143
K-4.2 Cl-107 HCO3-21* AnGap-19
[**2154-9-15**] 06:02AM BLOOD Glucose-101 UreaN-23* Creat-0.9 Na-142
K-3.6 Cl-104 HCO3-29 AnGap-13

[**2154-9-8**] 04:38AM BLOOD ALT-39 AST-51* LD(LDH)-295* CK(CPK)-59
AlkPhos-85 TotBili-1.2

[**2154-9-7**] 04:18PM BLOOD CK(CPK)-58
[**2154-9-7**] 09:30PM BLOOD CK(CPK)-62
[**2154-9-7**] 09:08PM BLOOD cTropnT-0.02*
[**2154-9-7**] 09:30PM BLOOD CK-MB-NotDone cTropnT-0.02*
[**2154-9-8**] 04:38AM BLOOD CK-MB-NotDone cTropnT-0.01 proBNP-8079*

[**2154-9-8**] 04:38AM BLOOD Calcium-7.5* Phos-3.6 Mg-1.8
[**2154-9-14**] 05:42AM BLOOD Calcium-8.5 Phos-3.7 Mg-1.8

[**2154-9-7**] 11:42PM BLOOD Type-ART pO2-506* pCO2-29* pH-7.45
calTCO2-21 Base XS--1
[**2154-9-8**] 03:21PM BLOOD Type-ART Tidal V-300 PEEP-5 FiO2-40
pO2-139* pCO2-30* pH-7.43 calTCO2-21 Base XS--2
Intubat-INTUBATED
[**2154-9-10**] 12:38AM BLOOD Type-ART Temp-36.8 pO2-163* pCO2-34*
pH-7.42 calTCO2-23 Base XS--1 Intubat-INTUBATED

[**2154-9-7**] 04:27PM BLOOD Lactate-3.4*
[**2154-9-7**] 09:30PM BLOOD Lactate-3.8*
[**2154-9-7**] 11:42PM BLOOD Lactate-1.9
.
======================
IMAGING:
TEE: [**9-9**]: No spontaneous echo contrast or thrombus is seen in
the body of the left atrium/left atrial appendage or the body of
the right atrium/right atrial appendage. The left atrial
appendage emptying velocity is depressed (<0.2m/s). The right
atrial appendage ejection velocity is depressed (<0.2m/s). No
atrial septal defect is seen by 2D or color Doppler. There is
symmetric left ventricular hypertrophy with normal cavity size.
LV systolic function appears depressed. There are simple
atheroma in the aortic arch and descending thoracic aorta to
47cm from the incisors. The aortic valve leaflets (3) are mildly
thickened. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Moderate to severe (3+)
mitral regurgitation is seen. There is a small pericardial
effusion.

IMPRESSION: No spontaneous echo contrast or thrombus in the
LA/LAA/RA/RAA. Moderate to severe mitral regurgitation. Mild
aortic regurgitation.
.
TTE [**7-16**]: The atria are moderately dilated. The right atrial
pressure is indeterminate. There is mild symmetric left
ventricular hypertrophy with normal cavity size and
regional/global systolic function (LVEF>55%). [Intrinsic left
ventricular systolic function is likely more depressed given the
severity of valvular regurgitation.] Transmitral Doppler and
tissue velocity imaging are consistent with Grade III/IV
(severe) LV diastolic dysfunction. The right ventricular free
wall is hypertrophied. Right ventricular chamber size is normal
with normal free wall contractility. There is abnormal systolic
septal motion/position consistent with right ventricular
pressure overload. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Moderate to severe
(3+) mitral regurgitation is seen. Moderate to severe [3+]
tricuspid regurgitation is seen. There is severe pulmonary
artery systolic hypertension. There is no pericardial effusion.

IMPRESSION: Mild symmetric left ventricular hypertrophy with
preserved global and regional biventricular systolic function.
Mild aortic regurgitation. Moderate to severe mitral
regurgitation. Moderate to severe tricuspid regurgitation.
Severe pulmonary hypertension.
Compared with the prior study (images reviewed) of [**2151-5-25**],
pulmonary pressures are higher. The other findings are simlar.
.
CXR [**2154-9-7**]:  Cardiac silhouette remains moderately enlarged.
There are bilateral pleural effusions, which appear new from the
prior study. The aorta remains tortuous with mural
calcifications present. Pulmonary ascularity is normal. The
osseous structures are unchanged. A retrocardiac opacity is
nonspecific, which may represent atelectasis, but infection is
excluded.

IMPRESSION:
1. Small bilateral pleural effusions.
2. Retrocardiac opacity, which could represent atelectasis, but
infection  not excluded.
3. No evidence of pulmonary edema.


Brief Hospital Course:
89F c diastolic dysfunction with worsening heart failure, atrial
fibrillation not on anticoagulation and mod-severe MR+TR who
presents with acute on chronic worsening of dyspnea.
.
# Dyspnea / Respiratory Failure: Differential diagnosis includes
CHF vs PNA vs MI. Given rapid decompensation with small fluid
bolus, and history of lack of fever, cough, no wbc,
non-impressive CXR, the most likely cause of her dyspnea was
acute on chronic diastolic heart failure, likely worsened
recently by afib. MI was ruled out with unremarkable EKG and
negative cardiac enzymes. In the MICU, patient was intially
intubated and sedated. After a TEE ruled out thrombus in the
heart, patient was cardioverted for persistent afib c RVR. She
was on heparin gtt during TEE and cardioversion. She was
successfully extubated and transferred to [**Hospital1 1516**] cardiology
service. After patient was transferred to cardiology floor, she
was diuresed with 20mg PO lasix daily, initially supplemented by
another dose of IV 10mg lasix in the afternoon. Patient
responded to lasix well, and her lung exams improved with
diuresis.
.
# Acute on chronic diastolic heart failure: Likely exacerbated
by Afib. After patient was transferred to cardiology floor, she
was diuresed with 20mg PO lasix daily, with another dose of IV
10mg lasix in the afternoon. Patient responded to lasix well,
and her lung exams improved with diuresis. Patient was
discharged with 20mg PO lasix daily.
.
# MR: Likely contributing to her fragile fluid balance and heart
failure.  She was hypertensive on admission.  We innitially were
able to decrease her afterload with intubation and PEEP, but
after extubation, her BPs were around 150s.  We restarted a low
dose ACEI for her. Blood pressure was in the 110s to 120s
afterwards.
.
# Afib: Patient was initially found to have afib when she had
appendicitis a year ago. She was not anticoagulated. Patient was
in persistent afib with RVR in MICU, so heparin drip was
started, and patient had a cardioversion after TEE showed no
thrombus. She was started on coumadin for bridging. She was very
sensitive to coumadin, INR was supratherapeutic after only 3
doses of coumadin (3mg, 3mg, 1mg), so coumadin was held.  The
plan is to re-start the patient's coumadin once INR < 3. She was
also loaded with amiodarone 400mg [**Hospital1 **] for 7 days, followed by
200mg [**Hospital1 **] for 7 days ([**Date range (1) 23728**]), and will start to take 200mg
daily from [**2154-9-22**]. After patient was transferred to cardiology
service on [**9-10**], she was started on low dose 12.5mg metoprolol
TID after she had 2 episodes of atrial tachycardia. She was
doing better in the next few days. However, she was noted to be
in junctional rhythm with a heart rate of 30s-40s, and SBP in
the 80s on [**9-13**]. It is likely that after 6 days of amiodarone on
board, she was finally seeing the effect of amiodarone. In the
mean time, she was on beta blocker. Both amio and BB had a
suppressive effect on the sinus node, and probably she has some
intrinsic nodal disease and the combination of all three caused
her to go into junctional rhythm. She had some retrograde p
waves on EKG, rp interval was prolonged, suggesting she not only
has sinus nodal disease but also has av block. Because of this
bradycardia and hypotension, she was obseved overnight at CCU
off beta blocker, and was doing well, so was transferred back to
cardiology. Patient was off beta blocker during the rest of her
hospital stay.
.
# Diabetes mellitus II: Metformin was held when patient was in
the hospital, as patient needed imaging and metformin can cause
elevated lactate. She was put on sliding scale humalong, and her
blood glucose was well controlled.
.
# Hypertension: Low dose lisinopril was restared after
extubation. Patient's blood pressure was stable during this
hospital stay.
.
# Hyperlipidemia: Home statin was continued.
.
# Lactate: In the ED, lactate was 3.4. It was most likely due to
poor tissue perfusion as a result of decompensated heart failure
vs metformin effect. Unlikely due to infection as patient had no
sign of infection. Metformin was held during this hospital stay.
Lactate returned to [**Location 213**] with 3L NS IVFs in ED.
.
# Postive blood culture: Blood culture from the Emergency room
grew coagulase negative staphylococcus in [**2-10**] tubes, however
patient had no sign of [**Last Name (LF) 23729**], [**First Name3 (LF) **] this was thought most
likely to be contamination. Patient was on vanc initially which
was discontinued. Patient was afebrile and had no sign of
[**First Name3 (LF) 23729**] during this hospital stay.
.
# Anemia: Hct was around 33-35, stable during this hospital
stay. Patient was found to have coffee grounds in NGT in MICU,
question TEE esophageal trauma. Patient was put on pantoprazole
40 mg IV Q12H, then was on PO pantoprazole. As a precaution,
active type and screen were maintained, but patient did not
require any blood transfusion.
.
# Hypokalemia: Patient had K of 3.0 after being transferred to
floor. Question lasix effect. Beta-blocker could also decrease
extracelluar K. Patient was not vomiting, so unlikely losing K
from GI tract. K was repleted with appropriate bump.
.
# Osteoporosis: Patient is on weekly fosamax.
.
# h/o Gout: Patient had no gout symptoms during this hospital
stay.
.
Patient had PICC line in place as she had very difficult IV
access. Her code status was full after discussion with her
daughter.


Medications on Admission:
Alendronate [Fosamax] 35 mg Tablet weekly (friday)
Atorvastatin [Lipitor] 10 mg daily
Furosemide 20 mg Tablet daily
Lisinopril 10 mg Tablet daily
Metformin 500 mg Tablet Sustained Release 24 hr daily
Metoprolol Succinate 50 mg daily
Polyethylene Glycol 17 gm daily
Aspirin 81 mg Tablet daily
Calcium 500 mg Tablet daily
Multivitamin daily


Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily). Tablet(s)
2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*28 Tablet(s)* Refills:*2*
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 7 days: day 1: [**9-15**]
day 7: [**9-21**].
Disp:*14 Tablet(s)* Refills:*0*
5. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
starting on [**2154-9-22**].
Disp:*30 Tablet(s)* Refills:*2*
6. Metformin 500 mg Tablet Sig: One (1) Tablet PO once a day.
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Polyethylene Glycol 3350 100 % Powder Sig: One (1)  PO DAILY
(Daily) as needed for constipation.
9. Calcium 500 mg Tablet Sig: One (1) Tablet PO once a day.
10. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
11. Fosamax 35 mg Tablet Sig: One (1) Tablet PO once a week: on
Fridays.
12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed for constipation.
13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
14. Coumadin 1 mg Tablet Sig: One (1) Tablet PO at bedtime:
Please start once INR < 3.
15. Outpatient Lab Work
INR check.  Please check INR daily. Once < 3, restart Coumadin


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Primary Diagnoses:
- Acute on chronic diastolic heart failure
- Atrial fibrillation treated with cardioversion

Secondary diagnosis:
- Hypertension
- Hyperlipidemia
- mod-to-severe MR
- mod-to-severe TR


Discharge Condition:
Stable, afebrile.


Discharge Instructions:
It was a pleasure to be involved in your care, Ms. [**Known lastname **]. You
were hospitalized to [**Hospital1 69**]
because of shortness of breath. You have a diagnosis of heart
failure that caused you to have too much fluid in your lungs.
You were treated with a medicine called "lasix" which removed
fluids from your lungs. Your symptom significantly improved on
this medication. You were also found to have an abnormal heart
rhythm called "atrial fibrillation", and you underwent a
procedure called "cardioversion" which stopped the bad rhythm.

Your medications have been changed.
-- please discontinue metoprolol succinate
-- please take 5mg lisinopril daily instead of 10mg daily
-- please take amiodarone 200mg twice a day from [**2154-9-15**] to [**9-21**],
thereafter take amiodarone 200mg once a day
-- please continue to take lasix 20mg daily

Please follow up with your doctors [**First Name (Titles) 3**] [**Last Name (Titles) 9304**] below.

If you develop worsening shortness of breath, chest pain,
palpitations, leg swelling, dizziness or any other symptom that
concerns you, please call your doctor or come back to the
Emergency Department immediately.

Followup Instructions:
You have an appointment with your cardiologist Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 437**]
on [**2154-9-23**] at 10:30am.

Please make an appointment to see your primary care doctor Dr.
[**Last Name (STitle) **],[**First Name3 (LF) **] [**Telephone/Fax (1) 8236**].


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 4074**]
{'Acute on chronic diastolic heart failure,Acute respiratory failure,Other primary cardiomyopathies,Atrial flutter,Dehydration,Mitral valve disorders,Unspecified essential hypertension,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Unspecified glaucoma,Gout, unspecified,Anemia, unspecified,Other postprocedural 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: dyspnea

PRESENT ILLNESS: 89 y/o F chinese-speaking female with severe diastolic heart
failure, atrial fibrillation not on anticoagulation, diabetes,
hypertension, hyperlipidemia who presents with worsening DOE/SOB
for past 3 days. Patient was seen for worsening dyspnea and
shortness of breath by Dr. [**First Name (STitle) 437**] in heart failure clinic [**2154-8-26**]
and at that time the patient's was started on lasix 20mg daily
and increased toprol dose. Per family, patient's lower extremity
edema improved, but dyspnea persisted. Also intermittant CP,
lasts >5min, occurring several times a day, no current pain and
no pain in ED.
.
In ED, Temp 97.5, HR 75 BP 123/91 RR 26 Pox 98 on 3 LNC. CXR
showed retrocardiac opacity and new bilateral pleural effusions.
No n/v, abd pain, f/c, cough, chest pain. In ED, he received
Levofloxacin 750 mg iv, and nitro SL. She initially had some
relief with better dyspnea after getting nitro. Got 250 ml bolus
and then had respiratory distress and was intuabted. Lactate
3.4.
.
On the floor, patient is intubated and sedated. Family is at the
bedside. She is in atrial fibrillation and her BP is stable.

MEDICAL HISTORY: -Severe diastolic congestive heart failure
-Pulm HTN
-Mod to severe mitral regurgitation
-Diabetes mellitus
-Hypertension
-Hyperlipidemia
-Osteoporosis
-Glaucoma
-h/o gout ([**3-18**])
-h/o appendicitis last year with septic shock ([**Hospital3 **])

MEDICATION ON ADMISSION: Alendronate [Fosamax] 35 mg Tablet weekly (friday)
Atorvastatin [Lipitor] 10 mg daily
Furosemide 20 mg Tablet daily
Lisinopril 10 mg Tablet daily
Metformin 500 mg Tablet Sustained Release 24 hr daily
Metoprolol Succinate 50 mg daily
Polyethylene Glycol 17 gm daily
Aspirin 81 mg Tablet daily
Calcium 500 mg Tablet daily
Multivitamin daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE on admission:
Vitals: T: 96.6, BP: 118/75, P: 93 (afib), R: 16, O2: 100% AC
100%/5/450/16 with ABG 7.45/29/506
General: thin, eldery, intubated and sedated
HEENT: Sclera anicteric, MMM, oropharynx clear, pupils 3mm and
reactive
Neck: supple, JVP not elevated, no LAD
Lungs: coarse lung sounds bilaterally, crackles at the bases, no
wheezes, referred ventilator sounds
CV: irregularly irregular, 2/6 systolic murmur best heard at
LLSB
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: cool, palp pulses, no clubbing, no edema

FAMILY HISTORY: Circulatory disorders in her father and uncle, otherwise
noncontributory.

SOCIAL HISTORY: The patient is originally from [**Female First Name (un) 8489**]. She lives in [**Location 583**] with
her daughter currently. [**Name2 (NI) **] tobacco use, no alcohol use, no drug
use.  Functional status is poor, but does get around the house
and has normal mental capacity, no known dementia. 

### Response:
{'Acute on chronic diastolic heart failure,Acute respiratory failure,Other primary cardiomyopathies,Atrial flutter,Dehydration,Mitral valve disorders,Unspecified essential hypertension,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other chronic pulmonary heart diseases,Osteoporosis, unspecified,Other and unspecified hyperlipidemia,Unspecified glaucoma,Gout, unspecified,Anemia, unspecified,Other postprocedural status'}
