CHIEF COMPLAINT: Referred from [**First Name3 (LF) **] lab after routine [**First Name3 (LF) 113**] showed pericardial
effusion with echocardiographic tamponade.

PRESENT ILLNESS: 52 year-old man with h/o metastatic esphogeal adenocarcinoma,
known pericardial effusion s/p pericardiocentesis with balloon
pericardotomy on [**2104-1-31**] who came to the [**Date Range 113**] lab today for
routine [**Date Range 113**] and was found to have tamponade physiology by TTE
(RV collapse on subcostals).  He was brought to the holding area
for possible pericardiocentesis; however, after evaluation by
cardiac surgery, decision was made to bring patient for
pericardial window procedure in the OR tomorrow.
.
The patient reports CP which he has had since placement of his
esophageal stent.  This is a constant pain, which he says is
secondary to his esophageal stent placement.  He tells me that
his fentanyl patch and prn dilaudid help to relieve this pain.
He reports SOB which he states has been present for 2 weeks, but
now improving.  He denies dizziness, blurry vision, cough,
fever, chills.  Some nausea and fatigue associated with his
chemotherapy.

MEDICAL HISTORY: 1) Metastatic Adenocarcinoma of Esophagus:
--> s/p 5 cycles cisplatin and 5-FU (completed in [**9-/2102**]); h/o
XRT, followed by consolidation chemotherapy alone and CyberKnife
radiation therapy to left pelvic metastasis in [**10-29**].
--> Course c/b RUE DVT related to line. [**7-/2103**], he began to
experience difficulty swallowing and subsequent evaluation
revealed local recurrence. Started irinotecan and cisplatin
--> Developed PE [**2103-11-18**], on Lovenox.
--> Periesophageal fluid collection: Found on CT [**2104-1-28**]; this
fluid
collection was conecerning for abscess vs necrotic lymph node.
Fluid collections were to small to drain (1.6cm x 1.5cm).  He
was treated with Zosyn and then 3 weeks of Augmentin.  Follow up
CT chest on [**2104-2-19**] showed resolution of fluid collection.
2) Hyperlipidemia
3) A fib: diagnosed on admission [**1-30**]
4) Anxiety

MEDICATION ON ADMISSION: - Senna 8.6 mg PO BID as needed
- Docusate 100 mg PO BID as needed
- Pantoprazole 40 mg PO Q24H
- Fentanyl 75 mcg/hr Patch 72HR Transdermal
- Lorazepam 0.5-1 mg PO Q4-6H as needed for nausea, anxiety.
- Toprol XL 200 mg PO once a day
- Hydromorphone 2 mg 1-2 Tablets PO Q4H as needed
- Enoxaparin 100 mg/mL Q12H

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  110/52 - 108 - 18 - 100%RA
PULSUS: 30-40 mmHg
Gen: middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva pink, no pallor or
cyanosis of the oral mucosa. Dry MM, OP clear, no exudate.
Neck: Supple; JVP at level of the mandible.
CV: RR, normal S1/S2. No m/r. No S3 or S4.
Chest: Resp were unlabored, no accessory muscle use. Left port
well appearing w/o erythema.  CTAB, no crackles, wheezes or
rhonchi.
Abd: Soft, NT, ND. No HSM or tenderness. +palpable mass in RLQ
(patient states that this is secondary to lovenox).
Ext: No c/c/e.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses: 1+ DP/PT pulses

FAMILY HISTORY: Mother had ovarian cancer at age 54, father MI age 48.  Multiple
family members on mother's side with "cancers."

SOCIAL HISTORY: Married, 18 and 15 year old sons.  [**Name (NI) 4084**] smoked. "social
drinker" no EtOH over the last 2 weeks.
Unspecified disease of pericardium,Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of bone and bone marrow,Atrial fibrillation,Pure hypercholesterolemia,Tachycardia, unspecified,Anxiety state, unspecified,Anemia of other chronic disease,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in other specified places,Personal history of venous thrombosis and embolism
Pericardial disease NOS,Mal neo esophagus NEC,Secondary malig neo bone,Atrial fibrillation,Pure hypercholesterolem,Tachycardia NOS,Anxiety state NOS,Anemia-other chronic dis,Adv eff antineoplastic,Accident in place NEC,Hx-ven thrombosis/embols
Admission Date:  [**2104-3-3**]              Discharge Date:   [**2104-3-8**]

Date of Birth:  [**2051-4-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Referred from [**First Name3 (LF) **] lab after routine [**First Name3 (LF) 113**] showed pericardial
effusion with echocardiographic tamponade.


Major Surgical or Invasive Procedure:
Left thoracotomy, partial pericardial resection,
evacuation of pericardial effusion and left pleural effusion.


History of Present Illness:
52 year-old man with h/o metastatic esphogeal adenocarcinoma,
known pericardial effusion s/p pericardiocentesis with balloon
pericardotomy on [**2104-1-31**] who came to the [**Date Range 113**] lab today for
routine [**Date Range 113**] and was found to have tamponade physiology by TTE
(RV collapse on subcostals).  He was brought to the holding area
for possible pericardiocentesis; however, after evaluation by
cardiac surgery, decision was made to bring patient for
pericardial window procedure in the OR tomorrow.
.
The patient reports CP which he has had since placement of his
esophageal stent.  This is a constant pain, which he says is
secondary to his esophageal stent placement.  He tells me that
his fentanyl patch and prn dilaudid help to relieve this pain.
He reports SOB which he states has been present for 2 weeks, but
now improving.  He denies dizziness, blurry vision, cough,
fever, chills.  Some nausea and fatigue associated with his
chemotherapy.


Past Medical History:
1) Metastatic Adenocarcinoma of Esophagus:
--> s/p 5 cycles cisplatin and 5-FU (completed in [**9-/2102**]); h/o
XRT, followed by consolidation chemotherapy alone and CyberKnife
radiation therapy to left pelvic metastasis in [**10-29**].
--> Course c/b RUE DVT related to line. [**7-/2103**], he began to
experience difficulty swallowing and subsequent evaluation
revealed local recurrence. Started irinotecan and cisplatin
--> Developed PE [**2103-11-18**], on Lovenox.
--> Periesophageal fluid collection: Found on CT [**2104-1-28**]; this
fluid
collection was conecerning for abscess vs necrotic lymph node.
Fluid collections were to small to drain (1.6cm x 1.5cm).  He
was treated with Zosyn and then 3 weeks of Augmentin.  Follow up
CT chest on [**2104-2-19**] showed resolution of fluid collection.
2) Hyperlipidemia
3) A fib: diagnosed on admission [**1-30**]
4) Anxiety


Social History:
Married, 18 and 15 year old sons.  [**Name (NI) 4084**] smoked. "social
drinker" no EtOH over the last 2 weeks.

Family History:
Mother had ovarian cancer at age 54, father MI age 48.  Multiple
family members on mother's side with "cancers."


Physical Exam:
VS:  110/52 - 108 - 18 - 100%RA
PULSUS: 30-40 mmHg
Gen: middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva pink, no pallor or
cyanosis of the oral mucosa. Dry MM, OP clear, no exudate.
Neck: Supple; JVP at level of the mandible.
CV: RR, normal S1/S2. No m/r. No S3 or S4.
Chest: Resp were unlabored, no accessory muscle use. Left port
well appearing w/o erythema.  CTAB, no crackles, wheezes or
rhonchi.
Abd: Soft, NT, ND. No HSM or tenderness. +palpable mass in RLQ
(patient states that this is secondary to lovenox).
Ext: No c/c/e.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses: 1+ DP/PT pulses


Pertinent Results:
REPORTS:
.
2D-ECHOCARDIOGRAM performed on [**2104-3-3**] demonstrated:
The left atrium is moderately dilated. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is low normal (LVEF 50-55%). The right ventricular
cavity is unusually small. Right ventricular systolic function
is borderline normal. The aortic valve leaflets (3) are mildly
thickened. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. There is a large pericardial effusion.
There is right ventricular diastolic compression, consistent
with impaired fillling/tamponade physiology. There is
significant, accentuated respiratory variation in
mitral/tricuspid valve inflows, consistent with impaired
ventricular filling. There is stranding/echodense material in
the pericardial space.
.
[**2104-3-4**]:
Pericardial fluid:
NEGATIVE FOR MALIGNANT CELLS.
.
[**2104-3-7**] TTE:
The left ventricular cavity size is normal. Due to suboptimal
technical
quality, a focal wall motion abnormality cannot be fully
excluded. Overall left ventricular systolic function is grossly
normal. Right ventricular
chamber size and free wall motion are normal. There is abnormal
septal motion suggestive of pericardial constriction. There is a
small pericardial effusion. The pericardium may be thickened.
There is significant, accentuated respiratory variation in
mitral/tricuspid valve inflows, consistent with impaired
ventricular filling. Otherwise, there is no echocardiographic
evidence of tamponade. Compared with the prior study (images
reviewed) of [**2104-3-3**], the pericardial effusion is now much
smaller.Septal bounce is now noted. A pleural effusion is
present in both studies.
.
LABS:
.
[**2104-3-8**] 06:48AM BLOOD WBC-6.3 RBC-3.20* Hgb-10.1* Hct-31.3*
MCV-98 MCH-31.6 MCHC-32.3 RDW-20.0* Plt Ct-167
[**2104-3-7**] 05:58AM BLOOD WBC-6.0 RBC-2.90* Hgb-9.2* Hct-28.3*
MCV-98 MCH-31.8 MCHC-32.6 RDW-20.4* Plt Ct-149*
[**2104-3-6**] 05:45AM BLOOD WBC-6.5 RBC-3.06* Hgb-9.9* Hct-29.7*
MCV-97 MCH-32.2* MCHC-33.2 RDW-20.4* Plt Ct-133*
[**2104-3-5**] 09:20PM BLOOD WBC-6.9 RBC-3.14* Hgb-10.1* Hct-30.5*
MCV-97 MCH-32.0 MCHC-33.0 RDW-20.7* Plt Ct-135*
[**2104-3-5**] 02:30AM BLOOD WBC-6.4 RBC-3.17* Hgb-10.3* Hct-30.7*
MCV-97 MCH-32.6* MCHC-33.6 RDW-21.5* Plt Ct-126*
[**2104-3-4**] 05:53PM BLOOD Hct-34.8*
[**2104-3-4**] 09:15AM BLOOD WBC-5.3 RBC-3.35*# Hgb-11.2*# Hct-32.2*#
MCV-96 MCH-33.3* MCHC-34.7 RDW-21.5* Plt Ct-132*
[**2104-3-3**] 04:00PM BLOOD WBC-4.6 RBC-2.50* Hgb-8.4* Hct-25.2*
MCV-101* MCH-33.6* MCHC-33.3 RDW-20.4* Plt Ct-118*
[**2104-3-8**] 06:48AM BLOOD Plt Ct-167
[**2104-3-8**] 06:48AM BLOOD PT-13.5* PTT-30.5 INR(PT)-1.2*
[**2104-3-7**] 05:58AM BLOOD Plt Ct-149*
[**2104-3-7**] 05:58AM BLOOD PT-14.7* PTT-31.4 INR(PT)-1.3*
[**2104-3-6**] 05:45AM BLOOD Plt Ct-133*
[**2104-3-6**] 05:45AM BLOOD PT-14.2* PTT-26.3 INR(PT)-1.3*
[**2104-3-5**] 09:20PM BLOOD Plt Ct-135*
[**2104-3-5**] 02:30AM BLOOD Plt Ct-126*
[**2104-3-4**] 09:15AM BLOOD Plt Ct-132*
[**2104-3-4**] 09:15AM BLOOD PT-14.1* PTT-26.2 INR(PT)-1.2*
[**2104-3-3**] 04:00PM BLOOD Plt Ct-118*
[**2104-3-3**] 04:00PM BLOOD PT-15.1* PTT-32.2 INR(PT)-1.4*
[**2104-3-3**] 04:00PM BLOOD Fibrino-570*#
[**2104-3-8**] 06:48AM BLOOD Glucose-93 UreaN-9 Creat-0.7 Na-140 K-3.6
Cl-104 HCO3-27 AnGap-13
[**2104-3-7**] 05:58AM BLOOD Glucose-100 UreaN-8 Creat-0.6 Na-138
K-4.0 Cl-103 HCO3-29 AnGap-10
[**2104-3-6**] 05:45AM BLOOD Glucose-106* UreaN-9 Creat-0.7 Na-137
K-3.9 Cl-102 HCO3-26 AnGap-13
[**2104-3-5**] 02:30AM BLOOD Glucose-113* UreaN-14 Creat-0.8 Na-134
K-4.3 Cl-102 HCO3-26 AnGap-10
[**2104-3-4**] 09:15AM BLOOD UreaN-14 Creat-0.9 Cl-105 HCO3-22
[**2104-3-3**] 04:00PM BLOOD Glucose-99 UreaN-13 Creat-0.9 Na-135
K-4.0 Cl-102 HCO3-25 AnGap-12
[**2104-3-3**] 04:00PM BLOOD ALT-23 AST-22 LD(LDH)-141 AlkPhos-79
Amylase-54 TotBili-0.5
[**2104-3-3**] 04:00PM BLOOD Lipase-32
[**2104-3-8**] 06:48AM BLOOD Calcium-8.6 Phos-3.9 Mg-2.0
[**2104-3-7**] 05:58AM BLOOD Calcium-8.2* Phos-3.5 Mg-1.9
[**2104-3-6**] 05:45AM BLOOD Calcium-8.5 Phos-3.3 Mg-1.6
[**2104-3-3**] 04:00PM BLOOD Albumin-3.3* Calcium-8.1* Phos-3.8 Mg-1.7
[**2104-3-3**] 04:00PM BLOOD Hapto-227*
[**2104-3-4**] 06:00PM BLOOD Type-[**Last Name (un) **] pH-7.31*
[**2104-3-4**] 09:22AM BLOOD Type-ART pO2-90 pCO2-44 pH-7.34*
calTCO2-25 Base XS--2
[**2104-3-4**] 07:41AM BLOOD Type-ART pO2-368* pCO2-54* pH-7.29*
calTCO2-27 Base XS--1
[**2104-3-4**] 06:00PM BLOOD K-4.6
[**2104-3-4**] 09:22AM BLOOD Glucose-118* Na-136 K-3.9
[**2104-3-4**] 07:41AM BLOOD Glucose-100 Na-137 K-4.4
[**2104-3-4**] 06:00PM BLOOD freeCa-1.17
[**2104-3-4**] 09:22AM BLOOD freeCa-1.11*
[**2104-3-4**] 07:41AM BLOOD freeCa-1.16

Brief Hospital Course:
52 yo man with h/o metastatic esphogeal adenocarcinoma, known
pericardial effusion s/p pericardiocentesis with balloon
pericardotomy on [**2104-1-31**], found to have tamponade physiology by
TTE, s/p pericardial window on [**3-4**].
***
# PERICARDIAL EFFUSION: Pt had known pericadial effusion s/p
recent tap w/ percutaneous pericardotomy. Cytology negative for
malignant cells, but low yield test for this cause. Followed w/
serial echos as outpatient, with echocardiographic evidence of
tamponade on admission. He was brought to holding area for
pericardiocentesis on admission, but decision was made for
patient to have pericardial window performed in OR. Initially
had clinical tamponade with pulsus of 30-40mmHg, but was
hemodynamicall stable. Pt underwent pericardial window on [**3-4**]
(Left thoracotomy, partial pericardial resection, evacuation of
pericardial effusion and left pleural effusion), with removal of
500cc bloody fluid and placement of L chest tube. L chest tube
was d/c'd on [**3-6**].
- pt was found again to have elevated pulsus of 40mm Hg, however
[**Month/Year (2) 113**] did not show signs of tamponade
- pericardial fluid and pericardial biopsy were negative for
malignant cells
- pt was tachycardic throughout the admission. His beta blocker
was held initially due to tamponade, however this was restarted
after the pericardial window procedure. His blood pressure
remained stable throughout the admission.
- held lovenox prior to procedure, then restarted. Hct remained
stable.
- pt to f/u with CT surgery 2 weeks after discharge
.
# H/O PE: patient w/ h/o PE. On outpatient lovenox.
- held lovenox prior to pericardial window procedure, and pt was
maintained on heparin. Pt was briefly off anticoagulation before
and after the procedure, but his Lovenox was quickly restarted
and his hct remained stable. He was discharged on his home dose
of lovenox.
.
# METASTATIC ESOPHAGEAL CANCER: managed by Dr. [**Last Name (STitle) 3274**] as an
outpatient.
- during the admission, pt's pain was controlled with a fentanyl
PCA, fentanyl patch, and dilaudid PO prn. Pt was then weaned off
of the PCA as his fentanyl patch dose was increased.
.
# H/O AFIB: remained in sinus during the admission.
- metoprolol held initially, then restarted and uptitrated back
to home dose.  Pt was discharged on his home dose of Toprol XL.
.
# FEN: cardiac diet with supplements
.
# ACCESS: L port
.
# CODE: Full Code

Medications on Admission:
- Senna 8.6 mg PO BID as needed
- Docusate 100 mg PO BID as needed
- Pantoprazole 40 mg PO Q24H
- Fentanyl 75 mcg/hr Patch 72HR Transdermal
- Lorazepam 0.5-1 mg PO Q4-6H as needed for nausea, anxiety.
- Toprol XL 200 mg PO once a day
- Hydromorphone 2 mg 1-2 Tablets PO Q4H as needed
- Enoxaparin 100 mg/mL Q12H

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Fentanyl 100 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
Disp:*10 Patch 72 hr(s)* Refills:*0*
4. Senna 8.6 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
5. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q8H (every 8
hours) as needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*
6. Toprol XL 200 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
7. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
8. Enoxaparin 100 mg/mL Syringe Sig: One Hundred (100) mg
Subcutaneous Q12H (every 12 hours).
Disp:*30 days* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
primary diagnosis:
pericardial effusion with cardiac tamponade

secondary diagnoses:
esophageal CA
DVT
PE


Discharge Condition:
Stable. Pain well controlled.


Discharge Instructions:
As you know, you had fluid and pressure around your heart when
you came in, which was improved by creating what is called a
"pericardial window."  This relieved the pressure.

You will have to see Dr. [**Last Name (STitle) **] in 2 weeks to have the staples
removed from your chest.  Until then, you cannot shower or get
the area wet.  You will do dressing changes as discussed with
the nurse prior to discharge.

Please seek medical attention immediately if you experience
chest pain, shortness of breath, nausea, vomiting, dizziness, or
any other concerning symptoms.

Please take all medications as prescribed.  We have not made any
changes to your regimen.

Please attend all follow-up appointments.

Followup Instructions:
You should follow-up with Dr.[**Name (NI) 3502**] office in 2 weeks to have
your clips removed.  The phone number for his office is
[**Telephone/Fax (1) **].  You also have an appointment with Dr. [**Last Name (STitle) **]
scheduled for [**4-14**] at 11:30 AM.

Dr. [**Last Name (STitle) 171**] (cardiology) would like to see you in follow up as
well.  Please call [**Telephone/Fax (1) 1989**] to schedule an appointment for
sometime in [**Month (only) **].

You have the following additional appointments scheduled:

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 25360**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2104-3-11**] 2:00

Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], RN Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2104-3-11**] 3:00



Completed by:[**2104-3-9**]
{'Unspecified disease of pericardium,Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of bone and bone marrow,Atrial fibrillation,Pure hypercholesterolemia,Tachycardia, unspecified,Anxiety state, unspecified,Anemia of other chronic disease,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in other specified places,Personal history of venous thrombosis and embolism'}


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: Referred from [**First Name3 (LF) **] lab after routine [**First Name3 (LF) 113**] showed pericardial
effusion with echocardiographic tamponade.

PRESENT ILLNESS: 52 year-old man with h/o metastatic esphogeal adenocarcinoma,
known pericardial effusion s/p pericardiocentesis with balloon
pericardotomy on [**2104-1-31**] who came to the [**Date Range 113**] lab today for
routine [**Date Range 113**] and was found to have tamponade physiology by TTE
(RV collapse on subcostals).  He was brought to the holding area
for possible pericardiocentesis; however, after evaluation by
cardiac surgery, decision was made to bring patient for
pericardial window procedure in the OR tomorrow.
.
The patient reports CP which he has had since placement of his
esophageal stent.  This is a constant pain, which he says is
secondary to his esophageal stent placement.  He tells me that
his fentanyl patch and prn dilaudid help to relieve this pain.
He reports SOB which he states has been present for 2 weeks, but
now improving.  He denies dizziness, blurry vision, cough,
fever, chills.  Some nausea and fatigue associated with his
chemotherapy.

MEDICAL HISTORY: 1) Metastatic Adenocarcinoma of Esophagus:
--> s/p 5 cycles cisplatin and 5-FU (completed in [**9-/2102**]); h/o
XRT, followed by consolidation chemotherapy alone and CyberKnife
radiation therapy to left pelvic metastasis in [**10-29**].
--> Course c/b RUE DVT related to line. [**7-/2103**], he began to
experience difficulty swallowing and subsequent evaluation
revealed local recurrence. Started irinotecan and cisplatin
--> Developed PE [**2103-11-18**], on Lovenox.
--> Periesophageal fluid collection: Found on CT [**2104-1-28**]; this
fluid
collection was conecerning for abscess vs necrotic lymph node.
Fluid collections were to small to drain (1.6cm x 1.5cm).  He
was treated with Zosyn and then 3 weeks of Augmentin.  Follow up
CT chest on [**2104-2-19**] showed resolution of fluid collection.
2) Hyperlipidemia
3) A fib: diagnosed on admission [**1-30**]
4) Anxiety

MEDICATION ON ADMISSION: - Senna 8.6 mg PO BID as needed
- Docusate 100 mg PO BID as needed
- Pantoprazole 40 mg PO Q24H
- Fentanyl 75 mcg/hr Patch 72HR Transdermal
- Lorazepam 0.5-1 mg PO Q4-6H as needed for nausea, anxiety.
- Toprol XL 200 mg PO once a day
- Hydromorphone 2 mg 1-2 Tablets PO Q4H as needed
- Enoxaparin 100 mg/mL Q12H

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  110/52 - 108 - 18 - 100%RA
PULSUS: 30-40 mmHg
Gen: middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva pink, no pallor or
cyanosis of the oral mucosa. Dry MM, OP clear, no exudate.
Neck: Supple; JVP at level of the mandible.
CV: RR, normal S1/S2. No m/r. No S3 or S4.
Chest: Resp were unlabored, no accessory muscle use. Left port
well appearing w/o erythema.  CTAB, no crackles, wheezes or
rhonchi.
Abd: Soft, NT, ND. No HSM or tenderness. +palpable mass in RLQ
(patient states that this is secondary to lovenox).
Ext: No c/c/e.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses: 1+ DP/PT pulses

FAMILY HISTORY: Mother had ovarian cancer at age 54, father MI age 48.  Multiple
family members on mother's side with "cancers."

SOCIAL HISTORY: Married, 18 and 15 year old sons.  [**Name (NI) 4084**] smoked. "social
drinker" no EtOH over the last 2 weeks. 

### Response:
{'Unspecified disease of pericardium,Malignant neoplasm of other specified part of esophagus,Secondary malignant neoplasm of bone and bone marrow,Atrial fibrillation,Pure hypercholesterolemia,Tachycardia, unspecified,Anxiety state, unspecified,Anemia of other chronic disease,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in other specified places,Personal history of venous thrombosis and embolism'}
